构建乳腺癌患者内分泌治疗后继发子宫内膜癌的预测模型

Establishment of prediction model of secondary endometrial carcinoma after endocrine therapy in breast cancer patients

目的构建预测模型以评判继发子宫内膜癌的预测价值,并验证其应用性。方法连续性纳入2013年4月至2014年4月期间太和医院所收治的根治术后接受内分泌治疗的乳腺癌患者为研究队列,收集相关临床资料,对其进行为期36个月的随访以确认预后转归。依据随访结果预判继发子宫内膜癌风险的影响性指标,并分析继发子宫内膜癌时间窗以验证该预测模型的应用性。结果最终收集253例符合本次临床试验要求的乳腺癌患者,其中23例患者于随访期内继发子宫内膜癌;Cox回归分析显示,乳腺癌患者内分泌治疗后继发子宫内膜癌的独立影响因素为已绝经、绝经时间、子宫内膜厚度、已服用他莫昔芬(tamoxifen,TAM)时间和雌二醇(E2)含量;绝经时间≥6.309年、子宫内膜厚度≥6.107 mm为其不良预后转归的评判临界值,具有更为显著的评判效能。结论已绝经、绝经时间、子宫内膜厚度、已服用TAM时间、E2含量是乳腺癌患者内分泌治疗后继发子宫内膜癌的独立危险因素,且绝经时间≥6.309年、子宫内膜厚度≥6.107 mm为衡量本病患者预后转归的临界点。

Objective To establish the predictive models to judge the predictive value of secondary endometrial cancer, and to verify its applicability. Methods The breast cancer patients who admitted to Taihe Hospital Affiliated to Hubei Medical University and received the endocrine therapy after the radical mastectomy from April 2013 to April2014 were selected as the research subjects. The clinical data of these patients was collected, and 36-month follow-up was performed to confirm the prognosis. The prognostic factors of secondary endometrial cancer were predicted according to the follow-up results, and the time window of secondary endometrial cancer was analyzed to verify the applicability of the predictive model. Results Finally, a total of 253 patients with breast cancer who met the requirements of this clinical trial were collected, of which 23 were followed up for secondary endometrial cancer during the follow-up period.Cox regression analysis showed that the independent influencing factors of secondary endometrial carcinoma after endocrine therapy in breast cancer patients were menopause, menopause time, endometrial thickness, taking tamoxifen（TAM） time and estradiol（E2） content. Menopausal time≥6. 309 years, endometrial thickness≥6.107 mm were the critical thresholds for the prognosis of adverse outcomes, and has a more significant evaluation effect. Conclusion Menstruation, menopause, endometrial thickness, taking TAM time, E2 content are the independent influencing factors of secondary endometrial carcinoma after endocrine therapy in breast cancer patients, and menopause time≥6.309 years, endometrial thickness≥6.107 mm are the critical thresholds for the prognosis of breast cancer patients during follow-up.