摘要
目的:基于病例对照试验分析三阴性乳腺癌(TNBC)保乳术后复发的影响因素,并据此构建预测方案。方法:回顾性分析2022年1月—2023年8月收治的186例行保乳术治疗的TNBC患者的临床资料,统计TNBC患者术后复发情况,将复发患者作为病例组,同时将年龄、产次、孕次、家族史作为匹配变量,按照1∶1比例匹配未复发患者作为对照组。比较两组临床资料,通过Cox模型分析TNBC保乳术后复发的影响因素,绘制TNBC保乳术后复发的列线图模型,并通过Bootstrap法对列线图进行内部验证,另通过校准曲线、ROC曲线评价模型的校准度、预测效能。结果:186例TNBC患者中,共有60例保乳术后出现复发,发生率为32.26%。病例组浸润性导管癌、TNM分期为Ⅲ期、肿瘤最大径>3 cm、淋巴结转移占比以及中性粒细胞/淋巴细胞比值(NLR)、增殖细胞抗原(Ki-67)水平均高于对照组(P<0.05);经Cox模型分析结果显示,浸润性导管癌、TNM分期为Ⅲ期、肿瘤最大径>3 cm、淋巴结转移以及NLR、Ki-67水平升高均是TNBC保乳术后复发的危险因素(P<0.05)。根据上述影响因素构建的列线图模型经Bootstrap法验证的一致性指数为0.886;校准曲线与理想曲线拟合度良好;ROC曲线显示,列线图模型预测TNBC保乳术后复发的曲线下面积、敏感度、特异度分别为0.837、71.67%、85.00%。结论:浸润性导管癌、TNM分期为Ⅲ期、肿瘤最大径>3 cm、淋巴结转移以及NLR、Ki-67水平升高均是TNBC保乳术后复发的危险因素,并且据此构建的列线图模型预测效能良好。
Objective:The influence factors of recurrence of triple negative breast cancer(TNBC)after breast con-serving surgery were analyzed based on case-control trials,and the prediction scheme was constructed accordingly.Method:The clinical data of 186 TNBC patients treated with breast conserving surgery from January 2022 to August 2023 were retrospectively analyzed,and the postoperative recurrence of TNBC patients was counted.The recurrent pa-tients were selected as the case group,while age,parity,pregnancy,and family history were used as matching variables,and non-recurrent patients were matched in a 1∶1 ratio as the control group.The clinical data of the two groups was compared.The influence factors of recurrence of TNBC after breast conserving surgery was analyzed by Cox model,and the nomogram model of recurrence after TNBC breast conserving surgery was drawn.The nomogram was internally verified by Bootstrap method.The calibration curve and ROC curve were used to evaluate the calibration and predictive efficacy of the model.Results:All of the 186 TNBC patients,60 cases had recurrence after breast conserving surgery,with an incidence of 32.26%.The proportions of invasive ductal carcinoma,TNM stage III,tumor size>3cm,lymph node metastasis ratio,and the levels of neutrophil/lymphocyte ratio(NLR)and proliferating cell antigen(Ki-67)in the case group were higher than those in the control group(P<0.05).The results of Cox model analysis showed that invasive duc-tal carcinoma,TNM stageⅢ,tumor size>3 cm,lymph node metastasis,and increased levels of NLR and Ki-67 were all risk factors for recurrence of TNBC after breast conserving surgery(P<0.05).The consistency index of the nomogram model constructed according to the above influence factors verified by Bootstrap method was 0.886.The calibration curve fitted well with the ideal curve.The ROC curve showed that the area under the curve,sensitivity and specificity of the nomogram model for predicting the recurrence of TNBC after breast conserving surgery were 0.837,71.67%and 85.00%,respectively.Conclusion:Invasive ductal carcinoma,TNM stageⅢ,tumor size>3 cm,lymph node metasta-sis,and increased levels of NLR and Ki-67 are all risk factors for recurrence of TNBC after breast conserving surgery,and the nomogram model constructed based on this has good predictive efficacy.
作者
张宁
杨良权
ZHANG Ning;YANG Liang-quan(Department of Breast,Qinhuangdao Maternal and Child Health Hospital,Qinhuangdao 066000,China)
出处
《中国现代普通外科进展》
2025年第9期692-696,共5页
Chinese Journal of Current Advances in General Surgery
基金
秦皇岛市科学技术研究与发展计划(202301A259)。
关键词
三阴性乳腺癌
保乳手术
病例对照试验
复发
列线图模型
Triple negative breast cancer
Breast conserving surgery
Case-control studies
Recurrence
Nomo-gram model
