乳腺癌新辅助化疗后Ⅱ水平腋窝淋巴结转移预测模型的建立和验证

发布时间：2018-03-10 04:33

本文选题：乳腺癌　切入点：新辅助化疗　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景乳腺癌是世界上最常见的癌症之一,是女性癌症相关的死亡的主要原因,其发病率仍在增加。由于新辅助化疗可以降低肿瘤负荷、有利于切除肿瘤及增加患者乳腺癌保乳率、评估肿瘤对药物的化疗反应和提供了重要的预后信息,因此越来越多的患者接受新辅助化疗。临床许多新辅助化疗后只有Ⅰ水平腋窝淋巴结转移,而没有Ⅱ水平淋巴结转移的乳腺癌患者,这些患者新辅助化疗后都行腋窝淋巴结清扫。一些临床试验表明,减少腋窝淋巴结清扫可以降低乳腺癌术后短期和长期的术后并发症的发生率,如淋巴水肿,肩关节活动受限和上臂麻木等,为患者提供更好的生活质量。我们的目的是建立一种预测列线图,在Ⅰ水平腋窝淋巴结转移的患者中,预测Ⅱ水平淋巴结转移风险,帮助临床医生制定适当的手术方案。方法我们回顾性分析从2010到2015期间新辅助化疗后424例经病理证实的Ⅰ水平淋巴结转移的乳腺癌患者,按1:1的比例随机分为建模组和验证组。对这些患者的临床和病理特点进行单因素和多因素分析。进行单因素和多因素分析后,筛选出Ⅱ水平腋窝淋巴结转移的独立预测因素。总数据、建模组数据、验证组数据进行单因素分析筛选出有统计学意义(P0.05)的变量后,然后进行多因素分析,筛选出Ⅱ水平腋窝淋巴结转移的独立预测因素。多因素分析后的独立预测因素(P0.05)被用来作为列线图的预测因子。该预测模型的Ⅱ水平腋窝淋巴结转移的独立预测因素来自于多因素分析。结果在新辅助化疗后的1108例患者中,其中612例乳腺癌患者有Ⅰ水平腋窝淋巴结转移。排除188例病例信息不完整的患者,最后纳入研究的患者数为424例。将424例患者按1:1的比例随机分为模型组(n=212)和验证组(n=212)。单因素分析后,肿瘤大小、组织学分级、新辅助化疗反应以及Ⅰ水平腋窝淋巴结转移数量具有统计学意义(P0.05)。建模组、验证组和总数据的单因素分析结果相同。将这些单因素分析有意义的变量纳入多因素分析,以此来确定新辅助化疗后Ⅱ水平腋窝淋巴结转移预测模型的独立预测因素。多因素分析显示,肿瘤大小、肿瘤组织学分级、新辅助化疗反应及Ⅰ水平腋窝淋巴结转移数量是该模型的独立预测因素。在建模组中,当截断值7%时,假阴性率2.6%;当截断值15%时,假阴性率为9.7%;当截断值20%时,假阴性率为11.1%。在验证组中,当截断值7%时,假阴性率4.7%;当截断值15%时,假阴性率为10.3%;当截断值20%时,假阴性率为12.0%。当Ⅱ水平腋窝淋巴结转移概率7%时,在建模组和验证组中,在这个低风险转移亚组分别占有约18.4%和20.1%的患者。也就是说,约20%的患者可以从Ⅱ水平腋窝淋巴结转移风险预测列线图受益。在建模组中,如果假阴性率设定为9.7%,Ⅱ水平腋窝淋巴结转移低风险亚组的患者可以占到近29.2%的患者。结论新辅助化疗后免除Ⅱ水平腋窝淋巴结清扫是乳腺癌腋窝淋巴结处理方式的重要转变。对于新辅助化疗后Ⅰ水平腋窝淋巴结转移的患者,该列线图可以用来预测Ⅱ水平腋窝淋巴结转移风险。因此,该模型可以为腋窝淋巴结治疗提供可靠的参考依据。我们的预测模型可以准确预测Ⅱ水平腋窝淋巴结转移风险,进而避免不必要的Ⅱ水平腋窝淋巴结清扫。
[Abstract]:Background: breast cancer is one of the most common cancers in the world, is the female leading cause of cancer-related deaths, the incidence is still increasing. The neoadjuvant chemotherapy can reduce the tumor load, is conducive to the removal of tumor and increase in patients with breast cancer rate, drug reaction and evaluation of tumor chemotherapy provides important prognostic information therefore, more and more patients received neoadjuvant chemotherapy. Many clinical chemotherapy only 1 level axillary lymph node metastasis, but not the level II lymph node metastasis in patients with breast cancer, neoadjuvant chemotherapy in these patients. After axillary lymph node dissection. Some clinical trials indicated that reduced axillary lymph node dissection can reduce breast cancer postoperative short-term and long-term postoperative complications, such as lymphedema, limitation of shoulder activity and arm numbness, provide a better quality of life for our patients. The purpose is to establish a predictive nomogram in the first level of axillary lymph node metastases, prediction of lymph node metastasis risk level, help clinicians make operation plan appropriate. Methods we retrospectively analyzed from 2010 to 2015 after neoadjuvant chemotherapy in 424 cases of pathologically confirmed lymph node metastasis of breast cancer patients, according to the ratio of 1:1 were randomly divided into model group and test group. Univariate and multivariate analysis of clinical and pathological features of these patients. Univariate and multivariate analysis, screening out the independent predictors of axillary lymph node metastasis II level. The total data modeling, data, data validation group single factor analysis showed that there was statistical significance (P0.05) variables, and multi factor analysis, selected independent predictors of axillary lymph node metastasis of level. Multivariate analysis independent prediction Factor (P0.05) were used as predictors of the nomogram from multivariate analysis. Independent predictors of axillary lymph node metastasis of the level of the forecast model. Results in the 1108 cases after neoadjuvant chemotherapy patients, including 612 cases of breast cancer patients with axillary lymph node metastasis. The serum levels in patients with 188 cases of information not completely excluded, finally into the number of patients studied for 424 cases. 424 patients according to the ratio of 1:1 were randomly divided into model group (n=212) and test group (n=212). After univariate analysis, tumor size, histological grade and response to neoadjuvant chemotherapy and the serum levels of axillary lymph node metastasis number statistically meaning (P0.05). The model group, the single factor test group and the total data analysis results. The single factor analysis of significant variables included in multivariate analysis, in order to determine the neoadjuvant chemotherapy on levels of axillary lymph node metastasis pre Independent predictors of measurement model. The multivariate analysis showed that tumor size, histological grade of tumor response to neoadjuvant chemotherapy, and the level of the number of axillary lymph node metastasis were independent predictors of the model. In the model group, when the cut-off value of 7%, false negative rate is 2.6%; when the cut-off value of 15%, false negative the rate is 9.7%; when the cut-off value of 20%, the false negative rate of 11.1%. in the validation group, when the cut-off value of 7%, false negative rate is 4.7%; when the cut-off value of 15%, false negative rate is 10.3%; when the cut-off value of 20%, false negative rate is 12.0%. when the level II axillary lymph node metastasis rate of almost 7% when, in the modeling and validation group, metastasis subgroup respectively occupy 18.4% and 20.1% of patients in the low risk. That is to say, about 20% of the patients from the level II axillary lymph node metastasis risk prediction nomogram benefit. In the modeling group, if the false negative rate is set to 9.7%, II level axillary lymph node Node metastasis low risk subgroup of patients can be accounted for nearly 29.2% of the patients. Conclusion after neoadjuvant chemotherapy from level II axillary lymph node dissection is an important transformation of axillary lymph node in breast cancer treatment. To study the level of axillary lymph node metastases after neoadjuvant chemotherapy, the nomograms can be used to predict the level of axillary lymph nodes node metastasis risk. Therefore, this model can provide a reliable reference for the treatment of axillary lymph node. Our prediction model can accurately predict the level of axillary lymph node metastasis risk, and avoid unnecessary axillary lymph node dissection. Level II

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9

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