摘要
目的应用超声特征及临床病理指标构建列线图模型,探讨其对T1、T2期乳腺癌患者腋窝淋巴结转移的预测价值。方法纳入2021年1月至2022年9月于西京医院诊治的经病理证实为T1、T2期乳腺癌的患者354例,根据腋窝淋巴结病理状态将其分为转移组125例与非转移组229例。采用单因素及多因素Logistic回归分析筛选独立预测因素,构建腋窝超声模型及综合模型(腋窝超声特征+乳腺超声特征+临床病理指标)。绘制ROC曲线评估模型的预测效能并通过Delong检验比较预测效能;绘制综合模型的列线图并通过Hosmer-Lemeshow检验、校准曲线、临床决策曲线分别评估模型的拟合优度、校准度及临床效用。结果淋巴结长短径比值、淋巴结形态分型、肿瘤最大径、结构扭曲、体质量指数(BMI)、组织学分级、雌激素受体(ER)为腋窝淋巴结转移的独立预测因素(均P<0.05)。腋窝超声模型、综合模型的ROC曲线下面积(AUC)分别为0.741(95%CI:0.684~0.758)、0.812(95%CI:0.767~0.858),综合模型的预测效能优于腋窝超声模型(Z=3.547,P<0.001)。结论在腋窝超声基础上结合乳腺癌超声特征和临床病理指标构建列线图模型,能够提升腋窝淋巴结转移的诊断性能,为乳腺癌的分期、预后和治疗提供有效参考。
Objective To construct a nomogram based on ultrasonic features and clinicopathological indicators and to explore its predictive value for axillary lymph node metastasis in patients with T1-2 breast cancer.Methods A total of 354 patients with histopathologically confirmed T1-2 breast cancer admitted to Xijing Hospital from January 2021 to September 2022 were included.According to whether there was axillary lymph node metastasis,the patients were divided into a metastatic group of 125 cases and a non-metastatic group of 229 cases.Univariate and multivariate Logistic regression analyses were used to screen independent predictors,and the axillary ultrasound model and comprehensive model(axillary ultrasound features+breast ultrasound features+clinicopathological indicators)were constructed.Receiver operating characteristic(ROC)curves were plotted to evaluate the predictive efficiency of the models,and the predictive efficiency was compared by the Delong's test.A nomogram of the comprehensive model was plotted,and the goodness of fit,calibration,and clinical utility of the model were evaluated by the Hosmer-Lemeshow test as well as calibration curve and decision curve analyses.Results The ratio of long diameter to short diameter of lymph nodes,morphological typing of lymph nodes,maximum tumor diameter,architectural distortion,body mass index,histological grade,and estrogen receptor status were identified to be independent predictors of axillary lymph node metastasis(P<0.05 for all).The areas under the ROC curves of the axillary ultrasound model and the comprehensive model were 0.741(0.684-0.758)and 0.812(0.767-0.858),respectively.The prediction efficiency of the comprehensive model was greater than that of the axillary ultrasound model(Z=3.5472,P<0.001).Conclusion The nomogram developed based on axillary ultrasonic features combined with clinicopathological indicators of breast cancer can improve the diagnostic efficiency for axillary lymph nodes metastasis,and provide effective reference for the staging,prognosis,and treatment of breast cancer.
作者
蔡林利
宋宏萍
巨艳
党晓智
韩铭
肖迎聪
Linli Cai;Hongping Song;Yan Ju;Xiaozhi Dang;Ming Han;Yingcong Xiao(Shool of Medical Technology,Shaanxi University of Chinese Medicine,Xi'an 712046,China;Department of Ultrasound,Xijing Hospital,the First Affiliated Hospital of Air Force Medical University,Xi'an 710032,China;Department of Pathology,Xijing Hospital,the First Affiliated Hospital of Air Force Medical University,Xi'an 710032,China)
出处
《中华医学超声杂志（电子版）》
CSCD
北大核心
2024年第2期143-150,共8页
Chinese Journal of Medical Ultrasound(Electronic Edition)
基金
国家自然科学基金面上项目(82071934)
陕西省科技计划项目国合重点项目(2020KWZ-022)
陕西省高等教育教学改革研究重点项目(21JZ009)
空军军医大学临床研究项目(2021LC2210)。
关键词
乳腺癌
淋巴结转移
超声检查
病理学
Breast cancer
Lymph node metastasis
Ultrasonography
Pathology
