Gail风险评估模型预测珠三角广佛地区女性散发性乳腺癌风险的适用性研究

Application of Gail risk assessment model for predicting the risk of sporadic breast cancer in Guangzhou-Foshan area of the Pearl River Delta

目的评估Gail风险评估模型预测珠三角广佛地区女性散发性乳腺癌风险的适用性及其临床效能。方法回顾性分析416例乳腺癌患者及170例乳腺良性增生患者5年前的临床资料,比较2组患者年龄、体质量指数(BMI)、月经初潮年龄、初产年龄、绝经年龄、足月产次数、乳腺良性疾病手术史、雌激素替代治疗、乳房周期性疼痛、乳腺癌家族病史、被动吸烟史、乳腺活检情况、种族等资料的差异。应用Gail乳腺癌风险评估模型测评工具评估5年乳腺癌发病风险。结果与乳腺良性增生组相比,乳腺癌组患者年龄偏大,BMI较高,月经初潮年龄延迟、初产年龄和绝经年龄提前,绝经患者和乳房周期性疼痛患者的比例较高(均P<0.05)。586例患者经Gail模型评估高风险为247例(42.2%),平均风险值(2.17±0.63)%;低风险者339例(57.8%),平均风险值(1.25±0.36)%。Gail模型预测乳腺癌患癌风险的敏感度45.4%,特异度65.8%,阳性预测值76.5%,阴性预测值33.9%,约登指数0.112。结论Gail风险评估模型对珠三角广佛地区女性散发性乳腺癌患病风险的评估尚不充分,大范围推广应用证据不足。

Objective To evaluate the applicability of Gail risk assessment model in predicting the risk of sporadic breast cancer among women in Guangzhou-Foshan area of Pearl River Delta,in order to evaluate its clinical value and efficacy.Methods Data of 416 cases of breast cancer patients and 170 healthy physical examination were retrospectively analyzed including age,body mass index(BMI),age at menarche,age at first delivery,age at menopause,number of full-term births,history of surgery for benign breast disease,estrogen replacement therapy,recurrent breast pain,family history of breast cancer,history of passive smoking,breast biopsy and ethnicity.The Gail breast cancer risk assessment model was used to assess the risk of breast cancer in five years.Results Compared with the benign breast hyperplasia group,the breast cancer group showed older age,higher BMI,higher age of menarche,earlier age of first childbirth and menopause,higher proportion of menopausal patients and higher proportion of patients with recurrent breast pain(all P<0.05).Among 586 patients,247(42.2%)cases were assessed as high risk by Gail model,with a mean risk value of(2.17±0.63)%,and 339(57.8%)were low-risk patients,with a mean risk of(1.25±0.36)%.The sensitivity,specificity,positive predictive value,negative predictive value and Youden index of Gail model were 45.4%,65.8%,76.5%,33.9%and 0.112.Conclusion Gail risk assessment model is not sufficient for the assessment of the risk of sporadic breast cancer among women in Guangzhou Foshan area of Pearl River Delta,and there is insufficient evidence for large-scale promotion and application.