乳腺癌新辅助化疗疗效预测模型的建立及其影响因素  

Establishment of a model for predicting the efficacy of neoadjuvant chemotherapy in breast cancer and its influencing factors

作　　者：丁红云 陆红梅[1] 黄丽 DING Hongyun;LU Hongmei;HUANG Li(Department of Radiotherapy,Nantong Cancer Hospital,Nantong Jiangsu 226361,China)

机构地区：[1]南通市肿瘤医院放疗科,江苏南通226361

出　　处：《临床与病理杂志》2023年第3期436-443,共8页Journal of Clinical and Pathological Research

摘　　要：目的:分析乳腺癌新辅助化疗疗效的影响因素,并建立疗效预测模型。方法:选择2019年7月至2022年7月南通市肿瘤医院收治的119例乳腺癌新辅助化疗患者,对所有患者临床资料进行回顾性分析。根据乳腺癌新辅助化疗后患者病理反应,将Miller-Payne(MP)分级为3~5级的患者作为有效组(n=70),MP分级为1~3级的患者作为无效组(n=49)。对患者疗效进行单因素分析与多因素logistic回归分析,并依据独立影响因素建立乳腺癌新辅助化疗疗效的预测模型。结果:119例乳腺癌新辅助化疗患者临床疗效有效率为35.29%(42/119)、无效率为64.71%(77/119),病理反应有效率为58.82%(70/119)、无效率为41.18%(49/119)。单因素分析显示:与无效组比较,有效组的组织学分级、雌激素受体(estrogen receptor,ER)、人表皮生长因子受体2(human epidermal growth factor receptor 2,HER2)、肿瘤增殖指数(Ki-67)表达状态差异均有统计学意义(均P<0.05)。多因素logistic回归分析显示:组织学分级、ER过表达型、Ki-67高表达最终进入回归方程(均P<0.05)。预测模型的曲线下面积(area under the curve,AUC)为0.775,有效概率的最佳截断值为0.693,灵敏度为0.498,特异度为0.872,阳性预测值为0.842,阴性预测值为0.563。结论:组织学分级、ER、Ki-67表达状态是影响乳腺癌新辅助化疗疗效的独立因素,根据该预测模型不能有效预测患者新辅助化疗疗效,仅可作为治疗参考。Objective:To analyze the influencing factors of the efficacy of neoadjuvant chemotherapy for breast cancer,and to establish an efficacy prediction model.Methods:A total of 119 patients with breast cancer who received neoadjuvant chemotherapy in Nantong Cancer Hospital from July 2019 to July 2022 were selected,and the clinical data of all patients were retrospectively analyzed.According to the pathological reaction of patients with breast cancer after neoadjuvant chemotherapy,the patients with Miller-Payne(MP)grading of 3−5 were regarded as an effective group(n=70),and the patients with MP grading of 1−3 were regarded as an ineffective group(n=49).The efficacy of patients was analyzed by single factor analysis and multifactor logistic regression analysis,and a prediction model of the efficacy of neoadjuvant chemotherapy for breast cancer was established based on independent influencing factors.Results:The clinical effective rate was 35.29%(42/119),the non-effective rate was 64.71%(77/119),the pathological response effective rate was 58.82%(70/119),and the non-effective rate was 41.18%(49/119)in 119 patients with breast cancer undergoing neoadjuvant chemotherapy.Single factor analysis showed that the histological grading,estrogen receptor(ER),human epidermal growth factor receptor 2(HER2),tumor proliferation index(Ki-67)expression status in the effective group were significantly different from those in the ineffective group(all P<0.05).Multi-factor logistic regression analysis showed that histological grading,ER overexpression,and Ki-67 overexpression finally entered the regression equation(all P<0.05).The area under the curve(AUC)of the prediction model was 0.775.The best cutoff value of the effective probability of the prediction model was 0.693,the sensitivity was 0.498,the specificity was 0.872,the positive predictive value was 0.842,and the negative predictive value was 0.563.Conclusion:Histological grading,ER,Ki-67 expression status are independent factors that affect the efficacy of neoadjuvant chemother

关 键 词：预测模型 乳腺癌 新辅助化疗 影响因素 

分 类 号：R737.9[医药卫生—肿瘤]