基于SEER数据库构建1~2枚淋巴结阳性且乳房全切的老年早期乳腺癌患者不同腋窝手术方式的生存预测模型

Prognostic nomogram for elderly breast cancer patients with 1-2 positive nodes who underwent mastectomy and different axillary surgeries:a SEER-based study

背景与目的:指南推荐1~2枚前哨淋巴结阳性的保乳并计划行全乳放疗的T1-2期乳腺癌患者可以豁免腋窝淋巴结清扫。探讨1~2枚淋巴结阳性且乳房全切的老年早期乳腺癌患者的预后危险因素,并构建不同腋窝处理手术方式下的生存预测模型。方法:从SEER数据库收集2010—2015年期间65岁及以上、T1-2期、1~2枚淋巴结阳性且乳房全切的乳腺癌患者并随机分为验证集和训练集。对训练集进行单因素及多因素COX比例风险回归分析筛选出影响总生存的独立预后因素,利用R软件构建预测患者3年和5年总生存率的列线图,利用一致性指数(C指数)和校正曲线对预测模型进行内部(训练集)和外部(验证集)验证。结果:共纳入4 863例患者,中位随访42个月,训练集(3 647例)和验证集(1 216例)的基线分布符合简单随机分组。将多因素COX回归分析筛选出的年龄、种族、婚姻状态、组织学分级、分子分型、T分期、腋窝手术方式、是否放化疗共9个总生存的独立风险因素(P<0.05)用于构建列线图预测模型。训练集(即内部验证)和验证集(即外部验证)的C指数分别为0.710(95%CI:0.689~0.731)和0.728(95%CI:0.691~0.765),两组的校正曲线均靠近45°参考线,表明列线图具有良好的预测能力。结论:本研究构建的列线图预测模型具有良好的预测价值,有利于指导临床对患者进行个体化治疗。

Background and purpose:Guidelines recommend that the axillary lymph node dissection can be omitted for T1-2 breast cancer patients with 1-2 positive sentinel lymph nodes who undergo breast-conserving mastectomy and whole breast radiation.This study aimed to explore the independent prognostic factors for elderly breast cancer patients with 1-2 positive lymph nodes who underwent mastectomy and construct a nomogram to predict their survival following different axillary surgeries.Methods:T1-2 invasive breast cancer patients with 1-2 positive nodes and mastectomy from 2010 to 2015 were extracted from the Surveillance,Epidemiology,and End Results(SEER)program and divided into the training cohort(n=3647)and the validation cohort(n=1216).Univariate and multivariate Cox analyses were used to identify independent risk factors for overall survival(OS).The nomogram was constructed to predict 3-and 5-year OS,which was validated by the concordance index(C-index)and calibration curves.Results:A total of 4863 patients were included with a 42 months median follow-up time.The nomogram was constructed by incorporating nine independent prognostic factors(age,race,marital status,grade,subtype,T stage,axillary surgery,radiation and chemotherapy)identified by multivariate Cox analysis(P<0.05).The C-index was 0.710(95%CI:0.689-0.731)in the training cohort and 0.728(95%CI:0.691-0.765)in the validation cohort.All calibration curves showed good predictive capabilities.Conclusion:The well-validated nomogram was constructed and could be useful for individual treatment in the clinic.