基于雄激素受体构建三阴性乳腺癌预后模型

Prognostic Model of Triple Negative Breast Cancer Based on Androgen Receptor

目的三阴性乳腺癌(TNBC)属于异质性疾病,TNM分期难以准确预测其预后。通过对雄激素受体(AR)在TNBC中的表达分析,构建了一种新的预后模型。方法回顾性纳入176例TNBC患者的肿瘤标本,免疫组化检测AR染色强度和AR阳性细胞占比,以两者评分的乘积(简称:AR乘积)作为AR结果。对患者进行随访,分析AR与预后的关系,根据COX回归分析结果构建预后指数(PI):PI=风险系数1X变量1+风险系数2×变量2+……+风险系数n×变量n,绘制生存风险的列线图。结果AR乘积:0分103例、1分15例、2分17例、3分1例、4分9例、6分10例、9分21例。AR乘积与年龄、病理学类型、组织学分级、Ki-67、TNM有关。TNM和AR乘积是无病生存率(DFS)的独立影响因素。PI=-0.535XAR乘积+BTNM。计算每个患者的PI并分组:低风险组(PI<-3,45例)、中风险组(-3≤PI<0、114例)、高风险组(PI≥0、17例)。三组间DFS、总生存率(OS)差异均有统计学意义。绘制列线图预测3年、5年DFS,其C指数为0.719,校正曲线捉示预测值和实际结果间基本重合,提示该列线图有较好的预测能力。结论AR阳性表达预示TNBC患者更好的预后。利用AR和TNM可以构建TNBC患者的预后模型,能更:准确地预测其预后。

Objective Triple-negative breast cancer(TNBC)is a heterogeneous disease,and TNM staging system is difficult to accurately predict its prognosis.In this paper,the androgen receptor(AR)and TNM were used to construct a new prognosis model.Methods The TNBC tumor samples of 176 patients were retrospective analyses.The AR staining intensity and the proportion of AR-positive cells were detected by immunohistochemistry.The product of the two scores was taken as the AR result(AR product).The relationship between AR and prognosis was analyzed after follow-up.A prognostic index(PI)was constructed according to the results of COX regression analysis;PI=risk coefficient 1×variable 1+risk coefficient 2×variable 2+…+risk coefficient n×variable n,then a nomogram was drawn to predict the prognosis.Results The results of the AR product were 0 points in 103 cases,1 in 15 cases,2 in 17 cases,3 in 1 case,4 in 9 cases,6 in 10 cases,and 9 in 21 cases.The AR product was related to age,pathological type,histological grade,Ki-67 and TNM.TNM and AR were independent influencing factors of disease-free survival(DFS).The PI formula was established as PI=-0.535 x AR product+BTNM.The PI of each patient was calculated and divided into three groups:low risk group(PI<-3,45 cases),medium risk group(-3≤PI<0,114 cases),high risk group(PI≥0,17 cases).There were significant differences in DFS and overall survival(OS)among the three groups.A nomogram was drawn to predict the 3-year and 5-year DFS.The C index of the nomogram was 0.719,and the correction curve indicated that the predicted value and the actual result basically coincide,which means the nomogram had a good prediction ability.Conclusion AR positive indicates a better prognosis in TNBC patients.By using AR and TNM,AR and TNM can be used to build the prognosis model of TNBC patients,which can more accurately predict the prognosis.