前哨淋巴结阳性乳腺癌患者非前哨淋巴结转移预测模型

Prediction model of non sentinel lymph node metastasis in sentinel lymph node positive breast cancer

目的预测前哨淋巴结阳性乳腺癌患者非前哨淋巴结是否转移具有非常重要的临床意义。本研究探讨前哨淋巴结阳性乳腺癌的非前哨淋巴结转移的危险因素,并构建非前哨淋巴结转移的预测模型,为预测前哨淋巴结阳性患者的非前哨淋巴结是否转移提供理论依据。方法回顾性分析广东省妇幼保健院2007-01-01-2016-07-31收治的206例前哨淋巴结阳性并且完成腋窝淋巴结清除术的乳腺癌患者临床病理资料。经单因素及多因素分析前哨淋巴结阳性乳腺癌的非前哨淋巴结转移的相关危险因素,用Logistic回归模型建立预测非前哨淋巴结转移风险的预测模型,并评估模型的准确度、敏感度、特异性。结果单因素及多因素分析均表明,脉管侵犯、ER阳性、前哨淋巴结转移率(阳性的前哨淋巴结数/总的前哨淋巴结数)为100%、前哨淋巴结包膜外侵犯与非前哨淋巴结转移密切相关,均P<0.05。预测模型的ROC曲线下面积为0.804,预测非前哨淋巴结状态的敏感度为74.2%(72/97),特异性为70.7%(53/75),总符合率72.7%(125/172)。验证模型的敏感度为77.8%(14/18),特异性为62.5%(10/16),总符合率70.6%(24/34)。结论本模型可以较好地预测前哨淋巴结阳性乳腺癌其非前哨淋巴结转移的风险,但模型的准确度仍需前瞻性多中心的验证进行评估。

OBJECTIVE To investigate the risk factors for non sentinel lymph node(NSLN)metastasis in sentinel lymph node(SLN)positive breast cancer and to establish the predictive model of non sentinel lymph node metastasis.And the study may contribute the theoretical basis for the prediction of NSLN metastasis in SLN positive breast cancer patients.METHODS We retrospectively analyzed the clinicopathologic features of 206 breast cancer patients with SLN positive in Guangdong Women and Children’s Hospital from January 2007 to July 2016,who underwent complete axillary lymph node dissection(ALND)after SLN biopsy.Univariate and multivariate analysis were used to analyze the correlation between clinicopathologic characteristics and non-SLN metastasis.A multivariable predictive model was created using logistics regression,and the accuracy,sensitivity and specificity of the model were verified.RESULTS Univariate and multivariate analysis showed that NSLN metastasis was associatied with vascular invasion,ER positive,SLN metastasis rate(positive SLN number/total number of SLN)is 100%,extranodal metastasis were significantly related to NSLN metastasis(P<0.05).The area under the ROC curve of the prediction model was 0.804,and the rate of sensitivity of predicting NSLN status was 74.2%(72/97),with a specificity of 70.7%(53/75),and the total coincidence rate was 72.7%(125/172).In addition,the rate of sensitivity,specificity and correction classified of the validation model were 77.8%(14/18),62.5%(10/16),70.6%(24/34),respective.CONCLUSION This prediction model can be used to assess the risk of additional axillary metastasis after positive SLNB in breast cancer,but the accuracy of the model is still need to be evaluated by prospective validation in multicenter.