列线图风险分层对pT_(1-2)N_(1)M_(0)期乳腺癌患者改良根治术后放疗的价值

The value of risk stratification of nomogram for post-mastectomy radiotherapy in patients with pT_(1-2)N_(1)M_(0)breast cancer

目的探讨pT_(1-2)N_(1)M_(0)期乳腺癌改良根治术后患者预后的高危影响因素,建立列线图预测模型,进行风险分层,筛选放疗获益人群。方法回顾性分析2010年1月至2016年12月河北医科大学第四医院936例pT_(1-2)N_(1)M_(0)期乳腺癌改良根治术后患者的临床资料,具有完整随访资料者908例,其中放疗(RT)组583例和非放疗(NRT)组325例,进行1∶1倾向评分匹配后两组各298例,采用log-rank检验比较两组患者总生存(OS)期、无瘤生存(DFS)期。建立列线图预测模型,比较不同风险分组人群的生存差异,筛选出放疗获益人群。结果单因素分析显示,放疗组5、8年OS、DFS明显优于非放疗组(P<0.001)。多因素分析显示:年龄、肿瘤象限、淋巴结转移数目、T分期、Ki-67水平是影响OS的独立预后因素;年龄、肿瘤象限、T分期是影响DFS的独立预后因素。OS列线图分析显示,改良根治术后放疗(PMRT)明显改善高危组患者OS(P=0.001),在低危组和中危组中未显示出优势(P=0.057、0.099)。DFS列线图分析显示,PMRT明显改善中危、高危组患者DFS(P=0.036、0.001),而低危组获益不明显(P=0.475)。结论对于pT_(1-2)N_(1)M_(0)期乳腺癌改良根治术后患者,年龄≤40岁、肿瘤位于内象限或中央区、T_(2)期、淋巴结转移2~3枚、Ki-67>30%是影响患者预后的高危因素。列线图预测模型能够筛选出可以从PMRT中获益的人群,为临床决策提供参考。

Objective To investigate the high-risk factors affecting the prognosis of patients with pT_(1-2)N_(1)M_(0)after mastectomy,establish a nomogram prediction model,perform risk stratification,and screen the radiotherapy benefit populations.Methods Clinical data of 936 patients with pT_(1-2)N_(1)M_(0)breast cancer undergoing mastectomy in the Fourth Hospital of Hebei Medical University from January 2010 to December 2016 were retrospectively analyzed and 908 cases had complete follow-up data.They were divided into the radiotherapy(RT)group(n=583)and non radiotherapy(NRT)group(n=325)according to the radiotherapy.After propensity score matching(PSM)was performed 1 vs.1,298 cases were assigned into the RT group and 298 in the NRT group.Overall survival(OS)and disease-free survival(DFS)were compared between two groups using log-rank test.Nomogram prediction model was established,the survival differences were compared among different risk groups,and the radiotherapy benefit populations were screened.Results Univariate analysis showed that the 5-and 8-year OS and DFS in the RT group were significantly better than those in the NRT group(both P<0.001).Multivariate analysis showed that age,tumor quadrant,number of lymph node metastases,T staging,and Ki-67 level were the independent prognostic factors for OS.Age,tumor quadrant,and T staging were the independent prognostic factors for DFS.The OS nomogram analysis showed that the OS of patients in the high-risk group was significantly improved by post-mastectomy radiotherapy(PMRT)(P=0.001),while PMRT did not show an advantage in the low-and medium-risk groups(P=0.057,P=0.099).The DFS nomogram analysis showed that DFS was significantly improved by PMRT in patients in the medium-and high-risk groups(P=0.036,P=0.001),whereas the benefits from PMRT were not significant in the low-risk group(P=0.475).Conclusions For patients with pT_(1-2)N_(1)M_(0)breast cancer after mastectomy,age≤40 years,tumor located in the inner quadrant or central area,T_(2) staging,2-3 lymph node metastases,Ki-67>30%are the high-risk factors affecting clinical prognosis.The nomogram prediction model can screen the populations that can benefit from PMRT,providing reference for clinical decision-making.