超声特征联合临床病理指标构建列线图预测T1期乳腺癌腋窝淋巴结转移

Ultrasound characteristics combined with clinicopathological indicators to construct a nomogram to predict axillary lymph node metastasis in T1 breast cancer

目的:建立联合原发病灶超声特征及临床病理指标预测T1期乳腺癌腋窝淋巴结转移风险的列线图并验证其临床价值。方法:回顾性分析2016年1月至2022年5月于石河子大学第一附属医院行手术及腋窝淋巴结清扫的536例T1期乳腺癌患者的超声资料及临床病理资料。通过单因素和多因素Logistic回归分析筛选出独立危险因素并制作列线图模型。运用ROC曲线、一致性指数、校准曲线验证列线图模型的区分度和一致性,决策曲线分析评估列线图模型的预测效能并使用Bootstrap重采样对模型进行内部验证。结果:多因素Logistic分析结果显示T1期乳腺癌肿块纵横比、Adler血流分级、T分期及HER-2表达状态是预测腋窝淋巴结转移的危险因素。基于以上4个指标构建列线图预测模型,其一致性指数为0.750(95%CI:0.704~0.796)。校准曲线、临床决策曲线分别提示模型一致性和临床应用效能良好。结论:联合原发病灶超声特征及临床病理指标所构建的列线图可有效预测T1期乳腺癌患者腋窝淋巴结转移风险,有助于为临床诊断、后期治疗及预后评估提供参考信息。

Objective:To establish a nomogram for predicting the risk of axillary lymph node metastasis in T1 breast cancer by combining with ultrasound characteristics and clinicopathological indicators of the primary lesions,and to verify its clinical value.Methods:The ultrasonographic and clinicopathological data of 536 cases with T1 breast cancer who underwent surgery and axillary lymph node dissection in the First Affiliated Hospital of Shihezi University from January 2016 to May 2022 were analyzed retrospectively.Univariate and multivariate Logistic regression analyses were used to identify independent risk factors,which were then used to build a nomogram model.The ROC curve,consistency index,and calibration curve were used to assess the discrimination and consistency of the nomogram model.Decision curve analysis was used to evaluate the predictive performance of the nomogram model,and Bootstrap resampling was used for internal validation of the model.Results:The results of multivariate Logistic analysis showed that the aspect ratio,Adler flow grade,T stage and HER-2 expression status of T1 breast cancer mass were the risk factors for predicting axillary lymph node metastasis.A Nomogram was established using the above 4 indicators and it showed a concordance index(C-index)of 0.750(95%CI:0.704~0.796).The calibration curve and clinical decision curve respectively indicated favourable consistency and clinical utility of the nomogram.Conclusion:The nomogram based on ultrasound characteristics and clinicopathological indicators of primary breast cancer lesions can effectively predict the risk of axillary lymph node metastasis in T1 breast cancer patients,and is helpful for providing reference information for clinical diagnosis,post-treatment and prognosis evaluation.