基于临床特征及超声征象构建乳腺癌患者术后复发的风险预测模型及其价值

Establishment and Value of Risk Prediction Model for Postoperative Recurrence of Breast Cancer Patients Based on Clinical Features and Ultrasound Signs

目的探讨乳腺癌患者术后复发的影响因素,并建立乳腺癌患者术后复发的风险预测模型。方法回顾性分析800例乳腺癌患者临床资料,根据术后复发情况分为复发组和未复发组,对比复发组和未复发组患者的临床资料及超声征象,采用多因素logistic回归模型分析术后复发的危险因素,并根据危险因素采用R(R3.5.3)软件建立列线图风险预警模型同时验证列线图模型的预测效能。结果800例乳腺癌手术患者中,术后复发35例,未复发765例,术后复发为4.38%(35/800)。复发组与未复发组患者年龄、居住地、BMI、受教育程度、月经、手术方式、肿瘤家族史、高血压、糖尿病、肿瘤形态、内部回声、后方回声、术后放疗、术后化疗、术后内分泌治疗等资料比较,差异无统计学意义(P>0.05),而肿瘤分期、肿瘤直径、边缘、纵横比、内钙化、腋淋巴结转移数等资料比较,差异有统计学意义(P<0.05);多因素结果显示,肿瘤分期Ⅲ期、肿瘤直径≥3 cm、边缘模糊、纵横比>1、内钙化、腋淋巴结转移数≥4个是乳腺癌术后复发的危险因素(P<0.05)。基于危险因素所构建的列线图模型的模型一致性指数为0.788,校正曲线与理想曲线基本一致,AUC值为0.766。结论肿瘤分期Ⅲ期、肿瘤直径≥3 cm、边缘模糊、纵横比>1、内钙化、腋淋巴结转移数≥4个均为乳腺癌患者术后复发的独立危险因素,基于上述因素构建的预测模型具有较好的风险预测价值。

Objective To explore the influencing factors of postoperative recurrence in breast cancer patients and establish a risk prediction model for postoperative recurrence in breast cancer patients.Methods The clinical data of 800 patients with breast cancer were retrospectively analyzed.According to the postoperative recurrence,they were divided into recurrent group and non recurrent group.The clinical data and ultrasonic signs of patients in the recurrent group and non recurrent group were compared.The risk factors of postoperative recurrence were analyzed by multivariate logistic regression model.According to the risk factors,R(R3.5.3)software was used to establish a nomogram risk early warning model and verify the predictive efficacy of the nomogram model.Results Among 800 cases of breast cancer,35 cases recurred after operation,765 cases did not recur,and the postoperative recurrence rate was 4.38%(35/800).The age,residence,BMI,education level,menstruation,operation mode,tumor family history,hypertension,diabetes,tumor morphology,internal echo,posterior echo,postoperative radiotherapy,postoperative chemotherapy,postoperative endocrine therapy and other data of patients in the recurrence group and the non recurrence group were compared,and there was no statistically significant difference(P>0.05),while the tumor stage,tumor diameter,margin,aspect ratio,internal calcification,number of axillary lymph node metastasis and other data were compared,and there was statistically significant difference(P<0.05);Multivariate results showed that tumor stageⅢ,tumor diameter≥3 cm,blurred margin,aspect ratio>1,internal calcification,axillary lymph node metastasis≥4 were risk factors for postoperative recurrence of breast cancer(P<0.05).The consistency index of the column chart model constructed based on risk factors was 0.788,the calibration curve was basically consistent with the ideal curve,and the AUC value was 0.766.Conclusion StageⅢ,tumor diameter≥3 cm,blurry margin,aspect ratio>1,internal calcification and axillary lymph node metastasis≥4 are independent risk factors for postoperative recurrence of breast cancer.The prediction model based on the above factors has good risk prediction value.