摘要
目的研究前哨淋巴结(sentinel lymph node,SLN)阳性乳腺癌患者腋窝非前哨淋巴结(NSLN)转移的危险因素,验证纪念斯隆-凯特琳癌症中心(MSKCC)腋窝NSLN转移预测模型评估乳腺癌患者的临床应用价值。方法回顾性地分析军事医学科学院附属医院普外科2000年1月至2011年3月175例成功行SLN活检且结果阳性、随即行腋窝淋巴结清扫的乳腺癌患者临床病理资料,使用MSKCC预测模型计算每例患者腋窝NSLN转移风险,利用校正曲线和受试者操作特性曲线(ROC)下面积(AUC)评估该模型预测的准确性。结果原发肿瘤大小、肿瘤是否多发、阳性SLN数、阳性SLN转移率、阴性SLN数与腋窝NSLN转移相关,P值分别为0.0018、0.0029、0.0049、0.0007、0.0002。多因素Logistic回归分析发现,原发肿瘤大小、肿瘤是否多发和阳性SLN数是NSLN转移的独立危险因素,P值分别为0.0022、0.0160、0.0176。校正曲线显示预测值曲线和真实值曲线趋势相近,MSKCC预测模型被验证的AUC值为0.79。结论对于SLN转移阳性的乳腺癌患者,原发肿瘤越小、肿瘤单发、阳性SLN数越少、阴性SLN数越多、阳性SLN转移率越低,其腋窝NSLN转移可能性越低,可对是否行腋窝淋巴结清扫提供参考。MSKCC预测模型可较准确地预测腋窝NSLN的转移风险。
Objective To analyze the risk factors of the non-sentinel lymph node （NSLN） metastasis in breast cancer patients with a positive sentinel lymph node （SLN）, and verify and evaluate its clinical value by the Memorial Sloan Ketter- ing Cancer Center （MSKCC） nomogram. Methods Clinical and pathological data were collected from 175 patients who received successful SLN biopsy with a metastasis positive resuh, followed by axillary lymph node dissection （ALND） from January 2000 to March 2011. Each patient＇s NSLN metastasis risk score was calculated using MSKCC nomogram. The cali- bration curve and the area under the receiver operating characteristic curve were used to assess the predictive accuracy of the model. Results Tumor size, multiple tumors, the number of positive SLN and negative SLN, and the positive SLN transfer ratio were correlated with NSLN metastasis, and P value was 0. 0018, 0. 0029, 0. 0049, 0. 0007, and 0. 0002, respectively. By multivariate analysis, tumor size, multiple tumors, and the number of positive SLN were identified as independent predictors of NSLN metastasis. The calibration curve showed the same trend between the predictive value curve and the real value curve. The AUC of MSKCC nomogram was 0.79. Conclusion There is a higher risk of axillary NSLN metastasis in SLN metastasis-positive breast cancer patients with tumors of bigger size, multiple tumors, a larger number of positive SLN and a high SLN positive rate. The MSKCC nomogram is a useful model to accurately predict the risk of metas- tasis of axillary NSLN.
出处
《军事医学》
CAS
CSCD
北大核心
2013年第12期917-921,共5页
Military Medical Sciences
