乳腺癌非前哨淋巴结转移预测模型验证性研究及ACIOSOG Z0011试验中国适宜人群的回顾性研究

发布时间：2018-05-17 19:46

  本文选题：乳腺癌 + 前哨淋巴结转移　； 参考：《济南大学》2015年硕士论文

【摘要】：目的:本研究通过回顾性分析前哨淋巴结(Sentinel Lymph Node,SLN)阳性患者的临床病理资料,探索非前哨淋巴结(NSLN)转移的危险因素,评估MSKCC模型在中国乳腺癌患者中的临床应用价值;再通过分析肿瘤负荷与NSLN转移之间的关系,进而评估Z0011试验标准对我国患者人群的可行性。方法:收集山东省肿瘤医院2001年12月至2015年1月接受前哨淋巴结活检的2431例乳腺癌患者,分析SLN阳性患者NSLN转移的危险因素。利用MSKCC模型计算每例患者NSLN转移风险,并通过受试者工作特征曲线(Receiver Operating Characteristic Curve,ROC)下面积(Area Under the Curve,AUC)评估该模型在中国乳腺癌患者中的临床应用价值。进一步筛选出除手术方式外均符合Z0011标准的患者,分析肿瘤负荷对NSLN阳性率的影响,并结合Z0011试验ALND组的相关数据,分析出与之相匹配的NSLN转移率所对应的肿瘤大小,进而得出更适宜中国人群的“Z0011试验标准”。结果:第一部分研究肿瘤大小、组织学分级、脉管浸润、多灶性、SLN阳性数和阴性数与NSLN转移差异有统计学意义(P0.05),其中肿瘤大小、组织学分级、脉管浸润、SLN阳性数和阴性数是NSLN转移的独立危险因素。趋势线显示预测值曲线和真实值曲线趋势基本相同,MSKCC列线图的AUC值为0.752。第二部分研究与Z0011试验ALND组的T1比例(49%vs 68%)存在统计学差异(P=0.006),肿瘤负荷偏高。NSLN(+)组与NSLN(-)组间肿瘤负荷(肿瘤大小及SLN阳性数)存在差异,且NSLN的阳性率及NSLN阳性数≥3枚的比例与肿瘤大小成正相关。肿瘤大小为T1的情况下NSLN阳性率为26.9%(83/308),与Z0011试验ALND组的NSLN阳性率最为相近。本研究中保乳患者与Z0011试验ALND进行对比分析可知:≤50岁患者的比例(72.0%vs 32.7%,P0.001)、激素受体阳性比例(28.9%vs 16.5%,P=0.002)存在统计学差异,T1所占比例(60.2%vs 67.9%,p=0.115)、病理类型(P=0.109)差异不存在统计学意义。结论:MSKCC列线图可以较准确的预测NSLN转移风险,为病人是否行腋窝淋巴结清扫术(ALND)提供参考依据。肿瘤大小及SLN阳性数对NSLN阳性率及转移程度存在影响。随着肿瘤大小的增加,NSLN阳性率及NSLN阳性数≥3枚的比例不断增高。通过结合Z0011试验ALND组的NSLN阳性率以及多种因素综合分析后建议:T1患者更适合作为Z0011试验中国适宜人群。
[Abstract]:Objective: to investigate the risk factors of nonsentinel lymph node metastasis by retrospectively analyzing the clinicopathological data of patients with Sentinel Lymph Nodetran (SLN) positive sentinel lymph nodes, and to evaluate the clinical value of MSKCC model in breast cancer in China. By analyzing the relationship between tumor load and NSLN metastasis, the feasibility of Z0011 test for Chinese patients was evaluated. Methods: 2431 breast cancer patients who received sentinel lymph node biopsy from December 2001 to January 2015 in Shandong Cancer Hospital were collected and the risk factors of NSLN metastasis in SLN positive patients were analyzed. The MSKCC model was used to calculate the risk of NSLN metastasis in each patient, and the clinical value of the model in Chinese breast cancer patients was evaluated by using the area Under the curve under the receiver Operating Characteristic curve. The patients who met the Z0011 standard except for the operation mode were screened out, and the effect of tumor load on NSLN positive rate was analyzed. The corresponding tumor size of NSLN metastasis rate was analyzed by combining the relevant data of ALND group with Z0011 test. Thus, the "Z0011 test standard" is more suitable for Chinese population. Results: in the first part, there were significant differences in tumor size, histological grade, vascular infiltration, positive and negative number of multiple foci and NSLN metastasis (P 0.05), including tumor size and histological grade. The number of positive and negative vascular infiltrations was an independent risk factor for NSLN metastasis. The trend line shows that the predicted value curve and the true value curve trend are basically the same. The AUC value of the MSKCC line diagram is 0.752. In the second part of the study, there was a statistical difference in T1 ratio of 49% vs 68 between the ALND group and the Z0011 trial group. There were significant differences in tumor load (tumor size and SLN positive number) between the high tumor load group and the NSLN- group. The positive rate of NSLN and the proportion of NSLN positive number 鈮，

本文编号：1902619