采用泛免疫炎症值预测乳腺癌新辅助化疗后腋窝淋巴结状态的临床研究  

Clinical study on the predictive value of the pan-immune inflammation value in assessing axillary lymph node status after neoadjuvant chemotherapy for breast cancer

作　　者：田卓宛 习一清 魏蕾[3] 陈芳芳[1] 张京伟[1] Tian Zhuowan;Xi Yiqing;Wei lei;Chen Fangfang;Zhang Jingwei(Department of Breast and Thyroid Surgery,Zhongnan Hospital of Wuhan University,Wuhan 430071,China;Department of Head and Neck Surgery,Hubei Cancer Hospital,Wuhan 430071,China;Department of Pathology and Pathophysiology,TaiKang Medical School,Wuhan 430071,China)

机构地区：[1]武汉大学中南医院甲乳外科,武汉430071 [2]湖北省肿瘤医院头颈外科,武汉430071 [3]武汉大学泰康医学院病理生理学教研室,武汉430071

出　　处：《中华实验外科杂志》2024年第12期2817-2820,共4页Chinese Journal of Experimental Surgery

基　　金：中国初级卫生保健基金会新锐肿瘤支持治疗课题研究项目(cphcf-2022-216)。

摘　　要：目的探究泛免疫炎症值(PIV)对乳腺癌新辅助化疗后腋窝淋巴结状态的预测作用及构建列线图模型。方法纳入2017年1月至2024年8月在武汉大学中南医院就诊的330例患者, 分为腋窝淋巴结病理完全缓解组(ypN0组)和腋窝淋巴结转移组(ypN+组)。采用单因素和多因素logistic分析逐步筛选变量以构建列线图模型, 使用受试者工作特征曲线下面积(AUC)和Hosmer-Lemeshow检验评价模型区分度和校准度, 使用净重新分类指数(NRI)和综合判别改善指数(IDI)评价引入PIV指标后预测性能改进情况。结果 PIV是新辅助化疗实现ypN0的独立影响因素[比值比(OR)=0.424, 95%置信区间(CI):0.220~0.801, P<0.05], 构建出包含PIV指标的预测模型AUC为0.873(95%CI:0.836~0.909), Hosmer-Lemeshow检验显示模型预测概率与实际观测结果高度一致(χ^(2)=4.790, P>0.05), NRI和IDI值分别为0.383和0.016。结论本研究构建出包含PIV指标的列线图模型可有效评估腋窝病理完全缓解率。ObjectiveTo explore the predictive role of the pan-immune inflammation value(PIV)in axillary lymph node status after neoadjuvant chemotherapy for breast cancer and construct a nomogram model.MethodsA total of 330 patients treated at Zhongnan Hospital of Wuhan University from January 2017 to August 2024 were included and divided into two groups:the axillary lymph node pathological complete response group(ypN0 group)and the axillary lymph node metastasis group(ypN+group).Univariate and multivariate logistic analyses were used to progressively screen variables for the construction of a nomogram model.The area under the receiver operating characteristic curve(AUC)and the Hosmer-Lemeshow test were adopted to evaluate the discrimination and calibration of the model respectively.The net reclassification index(NRI)and the integrated discrimination improvement index(IDI)were used to assess the improvement in predictive performance after introducing the PIV indicator.ResultsPIV emerged as an independent influencing factor for achieving ypN0 in neoadjuvant chemotherapy[odds ratio(OR)=0.424,95%confidence interval(CI):0.220~0.801,P<0.05].The AUC of the prediction model incorporating the PIV indicator was 0.873(95%CI:0.836~0.909).The Hosmer-Lemeshow test indicated a high consistency between the predicted and observed results(χ^(2)=4.790,P>0.05).The NRI and IDI values were 0.383 and 0.016 respectively.ConclusionThe constructed nomogram model with PIV index can effectively evaluate the rate of axillary pathologic complete response.

关 键 词：泛免疫炎症值 乳腺癌 腋窝淋巴结 新辅助化疗 预测模型 病理完全缓解 

分 类 号：R737.9[医药卫生—肿瘤]