Lambert Laura A, Ayers Gregory D, Hwang Rosa F, Hunt Kelly K, Ross Merrick I, Kuerer Henry M, Singletary S Eva, Babiera Gildy V, Ames Frederick C, Feig Barry, Lucci Anthony, Krishnamurthy Savitri, Meric-Bernstam Funda
Department of Surgical Oncology, Unit 444, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030, USA.
Ann Surg Oncol. 2006 Mar;13(3):310-20. doi: 10.1245/ASO.2006.03.078. Epub 2006 Feb 10.
Although completion lymph node dissection (CLND) is the standard of care for breast cancer patients with sentinel lymph node (SLN) metastases, the SLN is the only node with tumor in 40% to 60% of cases. To assist with decision-making regarding CLND, investigators at Memorial Sloan-Kettering Cancer Center devised and validated a nomogram for predicting the likelihood of non-SLN metastases. To assess the generalizable use of this nomogram, validation analysis was performed by using an external database.
Eight clinicopathologic variables for 200 consecutive breast cancer patients at the University of Texas M. D. Anderson Cancer Center with SLN metastases and CLND were entered into the nomogram. The accuracy of the nomogram to predict non-SLN metastases was assessed by the receiver operating characteristic (ROC) curve and linear regression analysis. The accuracy of the nomogram with touch-imprint cytology (TIC) as a substitute variable for frozen section was also evaluated.
The linear correlation coefficient of the nomogram-predicted probabilities correlated with the observed incidence of non-SLN metastases for all patients (.97). The accuracy of the nomogram as measured by the area under the ROC curve was .71. When applied solely to patients who had TIC assessment of the SLN, the area under the ROC curve was .74.
This study validated the Memorial Sloan-Kettering Cancer Center breast cancer nomogram by using an external database. TIC seems to be an acceptable substitute for frozen section as a nomogram variable. The nomogram may help predict an individual's risk of non-SLN metastases and assist in patient decision making regarding the benefit of CLND.
尽管完成淋巴结清扫术（CLND）是前哨淋巴结（SLN）转移的乳腺癌患者的标准治疗方法，但在40%至60%的病例中，SLN是唯一有肿瘤的淋巴结。为了辅助关于CLND的决策，纪念斯隆凯特琳癌症中心的研究人员设计并验证了一种用于预测非前哨淋巴结转移可能性的列线图。为了评估该列线图的广泛适用性，使用外部数据库进行了验证分析。
将德克萨斯大学MD安德森癌症中心连续200例有SLN转移且接受CLND的乳腺癌患者的8个临床病理变量输入列线图。通过受试者操作特征（ROC）曲线和线性回归分析评估列线图预测非前哨淋巴结转移的准确性。还评估了将触摸印片细胞学（TIC）作为冰冻切片替代变量的列线图的准确性。
列线图预测概率与所有患者非前哨淋巴结转移的观察发生率的线性相关系数为0.97。通过ROC曲线下面积测量的列线图准确性为0.71。仅应用于对SLN进行TIC评估的患者时，ROC曲线下面积为0.74。
本研究使用外部数据库验证了纪念斯隆凯特琳癌症中心的乳腺癌列线图。TIC似乎是作为列线图变量的冰冻切片的可接受替代物。该列线图可能有助于预测个体非前哨淋巴结转移的风险，并协助患者就CLND的获益做出决策。
