乳腺癌术后上肢淋巴水肿风险预测模型的构建及验证

Establishment and verification of risk prediction model for upper extremity lymphedema after breast cancer surgery

目的分析乳腺癌术后上肢淋巴水肿的危险因素,建立并验证风险预测模型。方法选取2017年6月~2018年12月在我院手术治疗的325例乳腺癌患者构建乳腺癌术后上肢淋巴水肿风险预测模型。选取57例乳腺癌术后患者验证模型的效能。采用周径测量法评估患者上肢淋巴水肿的发生情况。结果共有69例(21.2%)患者出现上肢淋巴水肿,其中轻度31例,中度24例,重度14例。单因素分析显示:高血压、体质指数、术后辅助放疗以及腋窝淋巴结清扫与淋巴水肿有关(P<0.05);多因素分析显示:高血压、体质指数、术后辅助放疗以及腋窝淋巴结清扫是淋巴水肿的独立危险因素(P<0.05)。构建的预测模型ROC曲线下面积为0.826[95%CI(0.772,0.880)],最大约登指数为0.517,灵敏度和特异度分别为84.1%和70.6%。实际应用的灵敏度和特异度分别为81.3%和87.8%。结论本研究构建的模型预测效果良好,为发现乳腺癌术后上肢淋巴水肿高危人群并采取预防性干预措施提供重要参考。

Objective To analyze the risk factors of upper extremity lymphedema after breast cancer surgery,establish and verify the risk prediction model.Methods Selected 325 breast cancer patients who were surgically treated in our hospital from Jun 2017 to Dec 2018,establised the risk prediction model for upper extremity lymphedema after breast cacer surgery.57 postoperative breast cancer patients were selected to verify the efficacy of the model.The circumference measurement method was used to evaluate the occurrence of upper extremity lymphedema in patients.Results A total of 69 cases(21.2%)occured upper extremity lymphedema,of which 31 cases were mild,24 cases were moderate and 14 cases were severe.Univariate analysis showed that hypertension,body mass index,postoperative adjuvant radiotherapy,axillary lymph node dissection were related to lymphedema(P<0.05).Multivariate analysis showed that hypertension,body mass index,postoperative adjuvant radiotherapy,axillary lymph node dissection were independent risk factors for lymphedema(P<0.05).The area under the ROC curve of the constructed prediction model was 0.826[95%CI(0.772,0.880)],the maximum Youden index was 0.517,and the sensitivity and specificity was 84.1%and 70.6%,respectively.The actual application sensitivity and specificity was 81.3%and 87.8%,respectively.Conclusion The model constructed in this study has good predictive effect and provides important reference to find high-risk groups of upper extremity lymphedema after breast cancer surgery and take preventive interventions.