三阴性乳腺癌化疗致重度骨髓抑制的危险因素分析及其预测模型的构建  

Risk Factors and Predictive Model for Severe Myelosuppression due to Chemotherapy in Triple-negative Breast Cancer

作　　者：黄家良[1] 夏坤健 郭伟 万成鹏 王琳[2] 唐娜 李顶 HUANG Jia-liang;XIA Kun-jian;GUO Wei;WAN Cheng-peng;WANG Lin;TANG Na;LI Ding(Department of General Surgery,The Second Affiliated Hospital of Jiujiang College,Jiujiang 332005,China;Department of Breast Surgery,The Second Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]九江学院第二附属医院普通外科,江西九江332005 [2]南昌大学第二附属医院乳腺外科,江西南昌330006

出　　处：《中山大学学报（医学科学版）》2023年第5期886-892,共7页Journal of Sun Yat-Sen University:Medical Sciences

摘　　要：【目的】探究三阴性乳腺癌(TNBC)化疗致重度骨髓抑制的危险因素,构建TNBC化疗致重度骨髓抑制的预测模型并对其进行验证。【方法】以2016年9月2日至2021年9月2日在南昌大学第二附属医院接受蒽环类联合环磷酰胺序贯紫杉醇化疗方案的TNBC病人为研究对象,分为重度骨髓抑制组与无/轻度骨髓抑制组。采用χ^(2)检验及二元logistic回归分析化疗致重度骨髓抑制的危险因素并建立预测模型。采用Hosmer-Lemeshow检验及受试者工作特征(ROC)曲线评价回归模型的预测效能。采用Kappa一致性检验对回归模型进行外部验证。【结果】本研究符合纳入和排除标准的乳腺癌患者207例。重度骨髓抑制患者106例(51%)。二元logistic回归多因素分析显示,年龄40~60岁(OR=3.463,95%CI:1.144~10.486,P=0.028)、年龄>60岁(OR=3.474,95%CI:1.004~12.020,P=0.049)、身体质量指数(BMI)18.5~24.0(OR=1.445,95%CI:0.686~3.087,P=0.328)、BMI<18.5(OR=3.582,95%CI:1.260~10.182,P=0.017)、肿瘤TNM分期Ⅱ期(OR=1.698,95%CI:0.831~3.468,P=0.146)、肿瘤TNM分期Ⅲ期(OR=2.943,95%CI:1.199~7.227,P=0.019)、既往糖尿病(OR=2.441,95%CI:1.076~5.539,P=0.033)、治疗前前白蛋白水平低下(OR=2.759,95%CI:1.141~6.669,P=0.024)以及治疗前淋巴细胞低下(OR=3.428,95%CI:1.689~6.958,P=0.001)是化疗致重度骨髓抑制的独立危险因素。logistic回归模型Hosmer-Lemeshow检验的χ^(2)值为11.507,P=0.175,ROC曲线下面积为0.763,标准误0.033,95%CI:0.698~0.828,P<0.001。外部验证显示,预测模型特异度为88%,灵敏度80%;Kappa值为0.679,标准误为0.081,P=0.000。【结论】此logistic回归模型具有较高的预测效能,对临床医师预测TNBC患者是否出现重度骨髓抑制有一定的参考价值。【Objective】To investigate the risk factors and construct a predictive model for severe myelosuppression due to chemotherapy in triple negative breast cancer(TNBC).【Methods】Patients with TNBC who received anthracycline combined with cyclophosphamide sequential paclitaxel chemotherapy regimen at the Second Affiliated Hospital of Nan⁃chang University from September 2,2016 to September 2,2021 were selected and assigned to severe myelosuppression group and no/mild myelosuppression group.Theχ^(2)test and binary logistic regression were used to analyze the risk factors for severe myelosuppression due to chemotherapy and to develop a prediction model.Hosmer-Lemeshow test and receiver operating characteristic(ROC)curve were used to evaluate the predictive efficiency of the regression model.Kappa consis⁃tency test was used to verify the regression model externally.【Results】A total of 207 patients who met the inclusion were enrolled and 106 patients(51%)had severe myelosuppression.Binary logistic regression multivariate analysis showed that age 40 to 60 years(OR=3.463,95%CI:1.144 to 10.486,P=0.028),age>60 years(OR=3.474,95%CI:1.004 to 12.020,P=0.049),body mass index(BMI)18.5 to 24.0(OR=1.445,95%CI:0.686 to 3.087,P=0.328),BMI<18.5(OR=3.582,95%CI:1.260 to 10.182,P=0.017),tumor TNM stageⅡ(OR=1.698,95%CI:0.831 to 3.468,P=0.146),tumor TNM stageⅢ(OR=2.943,95%CI:1.199 to 7.227,P=0.019),previous diabetes(OR=2.441,95%CI:1.076 to 5.539,P=0.033),low pre-treatment albumin level(OR=2.759,95%CI:1.141 to 6.669,P=0.024)and low pre-treatment lymphocytes(OR=3.428,95%CI:1.689 to 6.958,P=0.001)were independent risk fac⁃tors for severe myelosuppression due to chemotherapy.Theχ^(2)value for the logistic regression model Hosmer-Lemeshow test was 11.507,P=0.175,the area under the ROC curve was 0.763,standard error 0.033,95%CI:0.698-0.828,P=0.000.External validation showed that the prediction model had a specificity of 88%and a sensitivity of 80%;the kappa value was 0.679,standard error 0.081,P=0.000.【conclusion】This log

关 键 词：三阴性乳腺癌 辅助化疗 骨髓抑制 预测模型 危险因素 

分 类 号：R737.9[医药卫生—肿瘤]