Objective: To compare with fiveyear survival after surgery for the 116 breast cancer patients treated at the First Teaching Hospital (FTH) and the 866 breast cancer patients at Hpital du SaintSacrement (HSS). Methods...Objective: To compare with fiveyear survival after surgery for the 116 breast cancer patients treated at the First Teaching Hospital (FTH) and the 866 breast cancer patients at Hpital du SaintSacrement (HSS). Methods: Using Cox regression model, after eliminating the confounders, to develop the comparison of the fiveyear average hazard rates between two hospitals and among the levels of prognostic factors. Results: It has significant difference for the old patients (50 years old or more) between the two hospitals. Conclusion: Tumor size at pathology and involvement of lymph nodes were important prognostic factors.展开更多
Background:Methylene blue is the most commonly used tracer for sentinel lymph node(SLN)biopsy(SLNB)in China.This study aimed to investigate the feasibility of clinical application of SLNB using methylene blue dye(MBD)...Background:Methylene blue is the most commonly used tracer for sentinel lymph node(SLN)biopsy(SLNB)in China.This study aimed to investigate the feasibility of clinical application of SLNB using methylene blue dye(MBD)for early breast cancer and the prognosis of patients with different SLN and non-SLN statuses.Methods:We retrospectively analyzed the clinicopathological data of patients with early breast cancer treated at the Peking University First Hospital between 2013 and 2018.We calculated the SLN identification rate(IR)in SLNB with MBD and the false-negative rate(FNR),and analyzed the prognosis of patients with different SLN and non-SLN statuses using Kaplan-Meier curves.Results:Between January 2013 and December 2018,1603 patients with early breast cancer underwent SLNB with MBD.The SLN IR was 95.8%(1536/1603).Two SLNs(median)were detected per patient.There were significant differences in FNR between patients with SLN micrometastasis and macrometastasis(19.0%vs.4.5%,χ^(2)=12.771,P<0.001).Chi-square test showed that there were significant differences in SLN successful detection rates among patients with different vascular tumor embolism status(96.3%vs.90.8%,χ^(2)=9.013,P=0.003)and tumor(T)stages(96.6%vs.94.1%,χ^(2)=5.189,P=0.023).Multivariate analysis showed that vascular tumor embolism was the only independent factor for SLN successful detection(odds ratio:0.440,95%confidence interval:0.224-0.862,P=0.017).Survival analysis showed a significant difference in disease-free survival(DFS)between patients with non-SLN metastasis and patients without non-SLN metastasis(P=0.006).Conclusion:Our single-center data show that,as a commonly used tracer in SLNB in China,MBD has an acceptable SLN IR and a low FNR in frozen sections.This finding is consistent with reports of dual tracer-guided SLNB.Positive SLNs with non-SLN metastasis are associated with DFS.展开更多
背景随着乳腺癌(breast cancer,BC)治疗手段的进步,越来越多患者整体生存期延长,随之而来的是乳腺癌脑转移(breast cancer brain metastasis,BCBM)的增加,但BCBM患者的预后整体仍然较差。目的分析BCBM患者的预后因素,建立预测BCBM患者...背景随着乳腺癌(breast cancer,BC)治疗手段的进步,越来越多患者整体生存期延长,随之而来的是乳腺癌脑转移(breast cancer brain metastasis,BCBM)的增加,但BCBM患者的预后整体仍然较差。目的分析BCBM患者的预后因素,建立预测BCBM患者预后的临床列线图模型并评估其效能。方法纳入2001年1月—2021年6月于本中心诊断的BCBM患者,收其集临床病理特征,通过Cox回归分析确定患者预后因素,并建立预后预测列线图以预测BCBM患者6个月、1年、2年的生存率,通过ROC曲线和校准曲线对列线图的预测效能和校准度进行评价,采用Bootstrap方法进行内部验证。结果总计纳入700例患者,确诊BC时的平均年龄为43.77岁,中位总生存期为11(95%CI:9.8~12.2)个月。多因素Cox回归显示,BCBM患者较差预后与诊断BC时年龄>48岁(HR=1.30,95%CI:1.09~1.56,P=0.003)、诊断BCBM时KPS<80(HR=1.34,95%CI:1.13~1.60,P=0.001)、分型为三阴性乳腺癌(HR阳性/HER2阴性:HR=0.77,95%CI:0.60~0.98;HER2阳性:HR=0.62,95%CI:0.50~0.77;P<0.001)、首发转移部位非脑(HR=1.83,95%CI:1.44~2.32,P<0.001)、脑转移灶数目≥3个(HR=1.44,95%CI:1.20~1.72,P<0.001)、同时出现脑膜转移(HR=1.53,95%CI:1.12~2.08,P=0.008)、诊断BCBM后未接受放疗(HR=1.31,95%CI:1.10~1.57,P=0.003)、伴随肝转移(HR=1.28,95%CI:1.07~1.52,P=0.006)及伴随肺转移(HR=1.19,95%CI:1.00~1.42,P=0.049)独立关联。基于Cox回归构建预测BCBM患者生存率的列线图,其预测6个月、12个月、24个月生存的曲线下面积(area under curve,AUC)分别为0.723、0.720、0.798,内部验证显示模型预测各时间段平均AUC均>0.7,预测6个月、1年、2年生存的平均AUC及95%CI分别为:0.725(0.723~0.727),0.723(0.721~0.725),0.759(0.757~0.761)。校准曲线及决策曲线显示该模型具有良好精确度和临床获益。结论本研究开发了一种性能良好的预测BCBM患者预后的列线图。诊断BC时的年龄、诊断BCBM时的KPS、分子亚型、首发转移部位、脑转移灶数目是否≥3个、是否伴随脑膜转移、是否接受放疗、是否伴随肝转移及是否伴随肺转移为BCBM患者预后的独立影响因素。展开更多
文摘Objective: To compare with fiveyear survival after surgery for the 116 breast cancer patients treated at the First Teaching Hospital (FTH) and the 866 breast cancer patients at Hpital du SaintSacrement (HSS). Methods: Using Cox regression model, after eliminating the confounders, to develop the comparison of the fiveyear average hazard rates between two hospitals and among the levels of prognostic factors. Results: It has significant difference for the old patients (50 years old or more) between the two hospitals. Conclusion: Tumor size at pathology and involvement of lymph nodes were important prognostic factors.
基金Beijing Medical Award Foundation(No.YXJL-2016-0040-0065)Beijing Medical Award Foundation"Clinical efficacy of liquid biopsy for breast cancer"(No.2017-2019)+2 种基金Beijing Medical Award Foundation"Precision medical research on breast cancer"Beijing Medical Award Foundation Youth Program(No.2018-0304)National Key R&D Program of China(No.2016YFC0901302)。
文摘Background:Methylene blue is the most commonly used tracer for sentinel lymph node(SLN)biopsy(SLNB)in China.This study aimed to investigate the feasibility of clinical application of SLNB using methylene blue dye(MBD)for early breast cancer and the prognosis of patients with different SLN and non-SLN statuses.Methods:We retrospectively analyzed the clinicopathological data of patients with early breast cancer treated at the Peking University First Hospital between 2013 and 2018.We calculated the SLN identification rate(IR)in SLNB with MBD and the false-negative rate(FNR),and analyzed the prognosis of patients with different SLN and non-SLN statuses using Kaplan-Meier curves.Results:Between January 2013 and December 2018,1603 patients with early breast cancer underwent SLNB with MBD.The SLN IR was 95.8%(1536/1603).Two SLNs(median)were detected per patient.There were significant differences in FNR between patients with SLN micrometastasis and macrometastasis(19.0%vs.4.5%,χ^(2)=12.771,P<0.001).Chi-square test showed that there were significant differences in SLN successful detection rates among patients with different vascular tumor embolism status(96.3%vs.90.8%,χ^(2)=9.013,P=0.003)and tumor(T)stages(96.6%vs.94.1%,χ^(2)=5.189,P=0.023).Multivariate analysis showed that vascular tumor embolism was the only independent factor for SLN successful detection(odds ratio:0.440,95%confidence interval:0.224-0.862,P=0.017).Survival analysis showed a significant difference in disease-free survival(DFS)between patients with non-SLN metastasis and patients without non-SLN metastasis(P=0.006).Conclusion:Our single-center data show that,as a commonly used tracer in SLNB in China,MBD has an acceptable SLN IR and a low FNR in frozen sections.This finding is consistent with reports of dual tracer-guided SLNB.Positive SLNs with non-SLN metastasis are associated with DFS.
文摘背景随着乳腺癌(breast cancer,BC)治疗手段的进步,越来越多患者整体生存期延长,随之而来的是乳腺癌脑转移(breast cancer brain metastasis,BCBM)的增加,但BCBM患者的预后整体仍然较差。目的分析BCBM患者的预后因素,建立预测BCBM患者预后的临床列线图模型并评估其效能。方法纳入2001年1月—2021年6月于本中心诊断的BCBM患者,收其集临床病理特征,通过Cox回归分析确定患者预后因素,并建立预后预测列线图以预测BCBM患者6个月、1年、2年的生存率,通过ROC曲线和校准曲线对列线图的预测效能和校准度进行评价,采用Bootstrap方法进行内部验证。结果总计纳入700例患者,确诊BC时的平均年龄为43.77岁,中位总生存期为11(95%CI:9.8~12.2)个月。多因素Cox回归显示,BCBM患者较差预后与诊断BC时年龄>48岁(HR=1.30,95%CI:1.09~1.56,P=0.003)、诊断BCBM时KPS<80(HR=1.34,95%CI:1.13~1.60,P=0.001)、分型为三阴性乳腺癌(HR阳性/HER2阴性:HR=0.77,95%CI:0.60~0.98;HER2阳性:HR=0.62,95%CI:0.50~0.77;P<0.001)、首发转移部位非脑(HR=1.83,95%CI:1.44~2.32,P<0.001)、脑转移灶数目≥3个(HR=1.44,95%CI:1.20~1.72,P<0.001)、同时出现脑膜转移(HR=1.53,95%CI:1.12~2.08,P=0.008)、诊断BCBM后未接受放疗(HR=1.31,95%CI:1.10~1.57,P=0.003)、伴随肝转移(HR=1.28,95%CI:1.07~1.52,P=0.006)及伴随肺转移(HR=1.19,95%CI:1.00~1.42,P=0.049)独立关联。基于Cox回归构建预测BCBM患者生存率的列线图,其预测6个月、12个月、24个月生存的曲线下面积(area under curve,AUC)分别为0.723、0.720、0.798,内部验证显示模型预测各时间段平均AUC均>0.7,预测6个月、1年、2年生存的平均AUC及95%CI分别为:0.725(0.723~0.727),0.723(0.721~0.725),0.759(0.757~0.761)。校准曲线及决策曲线显示该模型具有良好精确度和临床获益。结论本研究开发了一种性能良好的预测BCBM患者预后的列线图。诊断BC时的年龄、诊断BCBM时的KPS、分子亚型、首发转移部位、脑转移灶数目是否≥3个、是否伴随脑膜转移、是否接受放疗、是否伴随肝转移及是否伴随肺转移为BCBM患者预后的独立影响因素。
