Gail乳腺癌模型应用价值及乳腺导管内乳头状肿瘤良恶性危险因素研究
发布时间：2018-08-18 15:00
【摘要】：第一部分Gai l乳腺癌模型应用价值研究目的:乳腺癌是女性最为常见的恶性肿瘤,早期发现与干预是降低乳腺癌危害的关键,欧美国家通过乳腺癌风险评估与大规模筛查等措施取得显著的成效。Gail乳腺癌风险评估模型是欧美国家最为常用的乳腺癌风险评估工具,本研究旨在探讨Gail乳腺癌风险评估模型在中国人群的适用性,评估其应用价值。资料与方法:系统性研究2015年1月至2016年12月间就诊于山东大学齐鲁医院经病理证实为乳腺癌患者150名;对照组按照年龄1:1匹配150人,对照组女性均行乳腺彩超或乳腺X线检查并至少经2名副主任职称以上乳腺外科医生诊断为健康女性(无乳腺疾病)。收集乳腺癌组与对照组女性年龄、月经初潮年龄、第一次生育年龄、既往乳腺活检史及是否伴有不典型增生、一级亲属乳腺癌发病人数、种族等信息,采用美国国家癌症研究中心(National Cancer Institute)官网发布的基于Gail乳腺癌风险评估模型的乳腺癌风险评估工具(Breast Cancer Risk Assessment Tool)分析研究对象5年前乳腺癌发病风险,对照患者实际发病情况研究Gail乳腺癌风险评估模型的应用价值。结果:Gail乳腺癌风险评估模型评估中国女性乳腺癌发病风险灵敏度为11.33%,特异度为93.33%,约登指数为0.047,ROC曲线下面积为0.533。结论 Gail乳腺癌风险评估模型对中国女性乳腺风险评估效果不理想。第二部分乳腺导管内乳头状肿瘤良恶性危险因素研究背景与目的:乳腺导管内乳头状肿瘤(Breast Intraductal Papillary Neoplasm,IDPN)是临床常见的一类乳腺疾病,指乳腺导管内增生的上皮被覆于纤维血管轴心的表面后形成树枝状结构改变的乳腺组织病变,伴有或不伴有肌上皮细胞层,包括良性、交界性、恶性三种病变。2012版《世界卫生组织乳腺肿瘤分类》中将乳腺导管内乳头状病变分为导管内乳头状瘤(包括中央型与外周型)、导管内乳头状瘤伴不典型导管增生和导管原位癌、导管内乳头状癌(包含导管内、包裹性、实性乳头状癌)。由于导管内乳头状肿瘤包含一组异质性肿瘤,临床表现、辅助检查、组织学特征存在重叠,给临床诊治带来巨大困难。本研究旨在分析归纳乳腺导管内乳头状肿瘤良恶性发病危险因素,建立导管内乳头状肿瘤良恶性风险模型,评估其应用价值。资料和方法:回顾性分析2008年01月至2015年12月间于山东大学齐鲁医院就诊行手术治疗经病理证实为乳腺导管内乳头状癌(包括导管内乳头状癌、实行乳头状癌、包裹性乳头状癌)病人90例,通过1:2年龄匹配(年龄±3岁)匹配手术病理证实为乳腺导管内乳头状瘤病人180例,详细研究对象信息。首先比较病例组与对照组之间的差异,采用单因素分析筛出选乳腺导管内乳头状肿瘤良恶性肿瘤的危险因素,针对单因素分析之中具有统计学意义的变量行多因素logistic回归分析,基于回归参数及临床意义行必要调整合理赋值,建立乳腺导管内乳头状肿瘤良恶性鉴别模型,使用ROC曲线选择合适的结点,探讨此方法的准确性与可行性。结果:单因素分析中共筛选出4个具有统计学差异的危险因素,分别是体重指数BMI(P0.05),既往导管内乳头状瘤病史(P0.05),月经状态(P0.05)乳腺癌家族史(P0.05),经过Logistic回归分析,最终得到的模型为:1n(P/1-P)=-1.140+0.514*X1+1.031*X2+0.444*X3+01.261*X4;经 ROC 曲线对Logistic模型进行评价,曲线下面积为0.653,95%置信区间为0.577-0.728。
[Abstract]:The first part is the application value of Gai l breast cancer model. Objective: Breast cancer is the most common malignant tumor in women. Early detection and intervention is the key to reduce the risk of breast cancer. Materials and Methods: A systematic study was conducted on 150 patients with breast cancer confirmed by pathology in Qilu Hospital of Shandong University from January 2015 to December 2016. The control group was divided into two groups according to the age of 1:1 pi. The age of women in breast cancer group and control group, menarche age, first birth age, previous breast biopsy history and atypical hyperplasia were collected. Breast Cancer Risk Assessment Tool (Breast Cancer Risk Assessment Tool), published on the official website of the National Cancer Institute, was used to analyze the risk of breast cancer five years ago. Results: The sensitivity, specificity, Jordan index and area under ROC curve of Gail breast cancer risk assessment model were 11.33%, 93.33%, 0.047 and 0.533 respectively. Conclusion Gail breast cancer risk assessment model has no significant effect on Chinese women breast cancer risk assessment. Objective: Breast intraductal Papillary Neoplasm (IDPN) is a common clinical breast disease. It refers to the dendritic structural alteration of the hyperplastic epithelium of the breast duct on the surface of the fibrovascular axis. Metaplastic breast tissue lesions with or without myoepithelial cell layers, including benign, borderline, and malignant lesions. The 2012 edition of the WHO Breast Tumor Classification classifies intraductal papillomas into intraductal papillomas (including central and peripheral types), intraductal papillomas with atypical ductal hyperplasia and ductogenesis. Intraductal papillary carcinoma (including intraductal, encapsulated, solid papillary carcinoma). Because intraductal papillary tumors contain a group of heterogeneous tumors, the overlap of clinical manifestations, auxiliary examinations, and histological features makes clinical diagnosis and treatment difficult. This study aims to analyze and summarize the risk of benign and malignant breast intraductal papillary tumors. Materials and Methods: From January 2008 to December 2015, we retrospectively analyzed the surgical treatment of intraductal papillary carcinoma (including intraductal papillary carcinoma, papillary carcinoma, encapsulated papillary carcinoma) in Qilu Hospital of Shandong University. Ninety patients with breast intraductal papilloma were confirmed by matching operation and pathology at 1:2 years old (age (+ 3 years old). Detailed information on the subjects was provided. First, the differences between the case group and the control group were compared, and the risk factors of benign and malignant breast intraductal papilloma were screened out by single factor analysis. Multivariate logistic regression analysis was used to identify the benign and malignant breast intraductal papillary neoplasms. The ROC curves were used to select the appropriate nodes to explore the accuracy and feasibility of the method. Four risk factors with statistical differences were screened out, including body mass index BMI (P 0.05), previous intraductal papillomatosis (P 0.05), menstrual status (P 0.05) family history of breast cancer (P 0.05). Logistic regression analysis showed that the final model was: 1n (P/1-P) = - 1.140 + 0.514 * X1 + 1.031 * X2 + 0.444 * X3 + 01.261 * X4; and Logis (P/1-P) = - 1.140 + 0.514 * X1 + 1.031 * X2 + 0.444 * X3 + The tic model was evaluated, the area under the curve was 0.653,95%, and the confidence interval was 0.577-0.728.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9
本文编号：2189831
[Abstract]:The first part is the application value of Gai l breast cancer model. Objective: Breast cancer is the most common malignant tumor in women. Early detection and intervention is the key to reduce the risk of breast cancer. Materials and Methods: A systematic study was conducted on 150 patients with breast cancer confirmed by pathology in Qilu Hospital of Shandong University from January 2015 to December 2016. The control group was divided into two groups according to the age of 1:1 pi. The age of women in breast cancer group and control group, menarche age, first birth age, previous breast biopsy history and atypical hyperplasia were collected. Breast Cancer Risk Assessment Tool (Breast Cancer Risk Assessment Tool), published on the official website of the National Cancer Institute, was used to analyze the risk of breast cancer five years ago. Results: The sensitivity, specificity, Jordan index and area under ROC curve of Gail breast cancer risk assessment model were 11.33%, 93.33%, 0.047 and 0.533 respectively. Conclusion Gail breast cancer risk assessment model has no significant effect on Chinese women breast cancer risk assessment. Objective: Breast intraductal Papillary Neoplasm (IDPN) is a common clinical breast disease. It refers to the dendritic structural alteration of the hyperplastic epithelium of the breast duct on the surface of the fibrovascular axis. Metaplastic breast tissue lesions with or without myoepithelial cell layers, including benign, borderline, and malignant lesions. The 2012 edition of the WHO Breast Tumor Classification classifies intraductal papillomas into intraductal papillomas (including central and peripheral types), intraductal papillomas with atypical ductal hyperplasia and ductogenesis. Intraductal papillary carcinoma (including intraductal, encapsulated, solid papillary carcinoma). Because intraductal papillary tumors contain a group of heterogeneous tumors, the overlap of clinical manifestations, auxiliary examinations, and histological features makes clinical diagnosis and treatment difficult. This study aims to analyze and summarize the risk of benign and malignant breast intraductal papillary tumors. Materials and Methods: From January 2008 to December 2015, we retrospectively analyzed the surgical treatment of intraductal papillary carcinoma (including intraductal papillary carcinoma, papillary carcinoma, encapsulated papillary carcinoma) in Qilu Hospital of Shandong University. Ninety patients with breast intraductal papilloma were confirmed by matching operation and pathology at 1:2 years old (age (+ 3 years old). Detailed information on the subjects was provided. First, the differences between the case group and the control group were compared, and the risk factors of benign and malignant breast intraductal papilloma were screened out by single factor analysis. Multivariate logistic regression analysis was used to identify the benign and malignant breast intraductal papillary neoplasms. The ROC curves were used to select the appropriate nodes to explore the accuracy and feasibility of the method. Four risk factors with statistical differences were screened out, including body mass index BMI (P 0.05), previous intraductal papillomatosis (P 0.05), menstrual status (P 0.05) family history of breast cancer (P 0.05). Logistic regression analysis showed that the final model was: 1n (P/1-P) = - 1.140 + 0.514 * X1 + 1.031 * X2 + 0.444 * X3 + 01.261 * X4; and Logis (P/1-P) = - 1.140 + 0.514 * X1 + 1.031 * X2 + 0.444 * X3 + The tic model was evaluated, the area under the curve was 0.653,95%, and the confidence interval was 0.577-0.728.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9
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