病例队列设计下新疆地区Luminal B型乳腺癌患者生存预后分析  

Analysis of Survival and Prognosis of Luminal B Breast Cancer Patients in Xinjiang based on Case-cohort Design

作　　者：吴梦娟 高春洁 张涛[1] 赵婷[2] 王蕾[3] WU Mengjuan;GAO Chunjie;ZHANG Tao;ZHAO Ting;WANG Lei(School of Public Health,Xinjiang Medical University,Urumqi 830017,China;Department of Medical Record Management,The Affiliated Cancer Hospital of Xinjiang Medical University,Urumqi 830017,China;Department of Medical Engineering and Technology,Xinjiang Medical University,Urumqi 830017,China)

机构地区：[1]新疆医科大学公共卫生学院,乌鲁木齐830017 [2]新疆医科大学附属肿瘤医院病案管理科,乌鲁木齐830017 [3]新疆医科大学医学工程技术学院,乌鲁木齐830017

出　　处：《宁夏医科大学学报》2025年第3期283-290,共8页Journal of Ningxia Medical University

基　　金：国家自然科学基金项目(12061079);“天山英才”青年科技创新人才培养项目(2022TSYCCX0108);新疆自然科学基金项目(2022D01C287)。

摘　　要：目的探讨新疆地区Luminal B型乳腺癌患者生存预后的影响因素。方法回顾性分析2015—2019年新疆医科大学附属肿瘤医院Luminal B型乳腺癌患者的临床数据,基于病例队列设计下加权Cox比例风险模型确定患者的独立预后因素并构建列线图;以全队列样本作为验证集进行外部验证,使用受试者工作特征(ROC)曲线、校准曲线以及临床决策曲线(DCA)评估模型的有效性以及临床实用性。结果单因素及多因素加权Cox比例风险模型结果显示,ER表达[HR=0.268,95%CI(0.118,0.607)]、PR表达[HR=0.599,95%CI(0.369,0.973)]、HER-2表达[HR=1.571,95%CI(1.044,2.366)]、临床分期Ⅱ期[HR=2.533,95%CI(1.460,4.394)]、Ⅲ期[HR=5.437,95%CI(3.101,9.534)]以及Ⅳ期[HR=21.359,95%CI(9.933,45.929)]接受术后治疗[HR=0.546,95%CI(0.375,0.795)]及保乳术[HR=0.366,95%CI(0.175,0.764)]、根治术[HR=0.536,95%CI(0.314,0.913)]是Luminal B型乳腺癌患者独立预后因素(P均<0.05)。通过纳入以上变量构建并验证预测患者1、4、7年总生存率的列线图,ROC曲线、校准曲线以及DCA曲线在病例队列与全队列样本中均证实该列线图具有良好的区分度、校准度以及临床实用性。结论基于病例队列设计下加权Cox比例风险模型构建的列线图对新疆Luminal B型乳腺癌患者的生存预后具有良好的预测价值,能够为个性化诊疗提供科学依据。Objective To explore the prognostic factors affecting the survival of patients with Luminal B breast cancer in Xinjiang.Methods We conducted a retrospective analysis of Luminal B breast cancer patients who were diagnosed in the Affiliated Cancer Hospital of Xinjiang Medical University from 2015 to 2019.Independent prognostic factors of patients were determined by using a weighted Cox proportional risk model under case-cohort design,and a nomogram was further developed.The external validation of the nomogram was performed by using the full cohort samples as the validation set.The receiver operating characteristic(ROC)curves,calibration curves,and clinical decision curves analysis(DCA)were used to evaluate the effectiveness and clinical practicality of this nomogram.Results The results of univariate and multivariate weighted Cox proportional risk models revealed that the ER expression[HR=0.268,95%CI(0.118,0.607)],PR expression[HR=0.599,95%CI(0.369,0.973)],HER-2 expression[HR=1.571,95%CI(1.044,2.366)],clinical stageⅡ[HR=2.533,95%CI(1.460,4.394)],stageⅢ[HR=5.437,95%CI(3.101,9.534)],stageⅣ[HR=21.359,95%CI(9.933,45.929)],postoperative therapy[HR=0.546,95%CI(0.375,0.795)],breast-conserving surgery[HR=0.366,95%CI(0.175,0.764)],and radical mastectomy[HR=0.536,95%CI(0.314,0.913)]were identified as independent prognostic factors for Luminal B breast cancer patients(P all<0.05).Additionally,by incorporating the variables mentioned above,a nomogram prediction model was constructed and validated to predict the 1,4 and 7 years overall survival rate of patients.The ROC curves,calibration curves,and DCA curves confirmed the nomogram exhibit good discrimination,calibration,and clinical practicality in both the case-cohort and the full cohort samples.Conclusion The nomogram constructed by the weighted Cox proportional risk model under the case-cohort design not only demonstrates strong predictive performance for the prognosis of Luminal B breast cancer patients in Xinjiang,but also provides scientific basis for personalized d

关 键 词：乳腺癌 Luminal B型 病例队列设计 生存预后 列线图 

分 类 号：R737.9[医药卫生—肿瘤]