基于术前超声、肿瘤组织miR-328、ITGA5构建乳腺癌术后复发转移的预警模型及验证  

Construction of an Early Warning Model and Validation for Postoperative Recurrence and Metastasis of Breast Cancer Based on Preoperative Ultrasound,Tumor Tissue miR-328 and ITGA5

作　　者：周桂萍 李建柱[2] 焦艳丽 李建梅 ZHOU Guiping;LI Jianzhu;JIAO Yanli;LI Jianmei(Department of Ultrasound,Qinhuangdao Hospital,Tianjin Cancer Hospital,Qinhuangdao,Hebei 066000,China;Department of Surgery,Qinhuangdao Hospital,Tianjin Cancer Hospital,Qinhuangdao,Hebei 066000,China;Department of Oncology,Qinhuangdao Hospital,Tianjin Cancer Hospital,Qinhuangdao,Hebei 066000,China)

机构地区：[1]天津市肿瘤医院秦皇岛医院超声科,河北秦皇岛066000 [2]天津市肿瘤医院秦皇岛医院外科,河北秦皇岛066000 [3]天津市肿瘤医院秦皇岛医院肿瘤内科,河北秦皇岛066000

出　　处：《临床误诊误治》2025年第9期37-44,共8页Clinical Misdiagnosis & Mistherapy

基　　金：2021年度河北省医学科学研究课题(20210772)。

摘　　要：目的 基于术前超声、肿瘤组织微小核糖核酸-328(miR-328)、蛋白整合素α5(ITGA5)构建乳腺癌术后复发转移的预警模型及验证。方法 回顾性分析2019年1月至2022年7月收治的行手术治疗乳腺癌患者286例的临床资料,根据术后2年复发转移情况分为复发转移组(n=62)、未复发转移组(n=224)。比较2组临床资料、术前超声参数(肿瘤直径、形态、毛刺征、微小钙化、Alder血流分级、灌注缺损、增强强度、增强模式、增强顺序、周围放射状增强)及肿瘤组织miR-328、ITGA5水平。多因素logistic回归分析乳腺癌术后复发转移的相关影响因素;基于多因素logistic回归分析结果运用R语言绘制乳腺癌术后复发转移的预警模型,并运用Hosmer-Lemeshow拟合优度、校准曲线、受试者工作特征曲线(ROC)、决策曲线分析(DCA)对所建立的模型进行验证。结果 术后2年,单纯同侧胸壁复发25例,单纯区域淋巴结复发34例,胸壁合并区域淋巴结复发3例;复发时间:6个月内2例(3.23%),1年内21例(33.87%),1~2年内39例(62.90%)。复发转移组形态不规则、微小钙化、灌注缺损、周围放射状增强、ITGA5高表达患者占比高于未复发转移组,miR-328低于未复发转移组(P<0.05,P<0.01);多因素logistic回归分析,形态不规则、微小钙化、灌注缺损、周围放射状增强、ITGA5高表达是乳腺癌术后复发转移的独立危险因素,miR-328升高是乳腺癌术后复发转移的独立保护因素(P<0.05,P<0.01)。基于多因素logistic回归分析结果:形态不规则、微小钙化、灌注缺损、周围放射状增强、miR-328、ITGA5建立乳腺癌术后复发转移的预警模型,该模型的C-index为0.837;内部评价与外部验证显示,Hosmer-Lemeshow拟合优度检验结果提示模型预测值与实际观测值之间的差异无统计学意义(P>0.05),预测模型有较好的校准能力;所建立的模型具有良好的区分度,校准曲线与理想曲线相贴合,各阈概率Objective To establish and validate a warning model for recurrence and metastasis of breast cancer based on preoperative ultrasound,tumor tissue microRNA-328(miR-328) and protein integrin α5(ITGA5).Methods The clinical data of 286 breast cancer patients who underwent surgery in our hospital from January 2019 to July 2022 were retrospectively analyzed.According to the recurrence and metastasis at 2 years after surgery,they were divided into recurrence and metastasis group(n=62) and non-recurrence and metastasis group(n=224).The clinical data,preoperative ultrasound parameters(tumor diameter,morphology,spiculation,microcalcification,Alder blood flow grade,perfusion defect,enhancement intensity,enhancement pattern,enhancement sequence,and peripheral radial enhancement) and the levels of miR-328 and ITGA5 in tumor tissues were compared between the two groups.Multivariate logistic regression was used to analyze the influencing factors of postoperative recurrence and metastasis of breast cancer.Based on the results of multivariate logistic regression analysis,R language was used to draw the early warning model of postoperative recurrence and metastasis of breast cancer,and Hosmer-Lemeshow goodness of fit,calibration curve,receiver operating characteristic(ROC) curve and decision curve analysis(DCA) were used to validate the established model.Results At 2 years after surgery,there were 25 patients with ipsilateral chest wall recurrence,34 patients with regional lymph node recurrence and 3 patients with both chest wall and regional lymph node recurrence.As for recurrence time,there was recurrence in 2 patients(3.23%) within 6 months,21 patients(33.87%) within 1 year,39 patients(62.90%) within 1-2 years.The proportion of patients with irregular morphology,microcalcification,perfusion defect,peripheral radial enhancement,and high expression of ITGA5 in the recurrence and metastasis group was higher than that in the non-recurrence and metastasis group,and miR-328 was lower than that in the non-recurrence and metastasis gro

关 键 词：乳腺肿瘤 超声检查 微小核糖核酸-328 蛋白整合素α5 肿瘤复发 灌注缺损 预警模型 危险因素 

分 类 号：R737.9[医药卫生—肿瘤]