Tvedskov Tove F, Jensen Maj-Britt, Balslev Eva, Kroman Niels
Department of Breast Surgery, Copenhagen University Hospital , Copenhagen , Denmark.
Acta Oncol. 2014 Feb;53(2):209-15. doi: 10.3109/0284186X.2013.806993. Epub 2013 Jun 17.
Benefit from axillary lymph node dissection in sentinel node positive breast cancer patients is under debate. Based on data from 1820 Danish breast cancer patients operated in 2002-2008, we have developed two models to predict high risk of non-sentinel node metastases when micrometastases or isolated tumor cells are found in sentinel node. The aim of this study was to validate these models in an independent Danish dataset.
We included 720 breast cancer patients with micrometastases and 180 with isolated tumor cells in sentinel node operated in 2009-2010 from the Danish Breast Cancer Cooperative Group database. Accuracy of the models was tested in this cohort by calculating area under the receiver operating characteristic curve (AUC) as well as sensitivity and specificity.
AUC for the model for patients with micrometastases was comparable to AUC in the original cohort: 0.63 and 0.64, respectively. The sensitivity and specificity for predicting risk of non-sentinel node metastases over 30% was 0.36 and 0.81, respectively, in the validation cohort. AUC for the model for patients with isolated tumor cells decreased from 0.73 in the original cohort to 0.60 in the validation cohort. When dividing patients with isolated tumor cells into high and low risk of non-sentinel node metastases according to number of risk factors present, 37% in the high-risk group had non-sentinel node metastases. Specificity and sensitivity was 0.48 and 0.88, respectively, in the validation cohort when using this cut-point.
In this independent dataset, the model for patients with micrometastases was robust with accuracy similar to the original cohort, while the model for patients with isolated tumor cells was less accurate. The models may be used to identify patients where axillary lymph node dissection should still be considered.
前哨淋巴结阳性乳腺癌患者行腋窝淋巴结清扫术的获益仍存在争议。基于2002年至2008年接受手术的1820例丹麦乳腺癌患者的数据，我们开发了两种模型，用于预测在前哨淋巴结中发现微转移或孤立肿瘤细胞时非前哨淋巴结转移的高风险。本研究的目的是在一个独立的丹麦数据集中验证这些模型。
我们从丹麦乳腺癌协作组数据库中纳入了2009年至2010年接受手术的720例前哨淋巴结有微转移的乳腺癌患者和180例有孤立肿瘤细胞的患者。通过计算受试者操作特征曲线（AUC）下面积以及敏感性和特异性，在该队列中测试模型的准确性。
微转移患者模型的AUC与原始队列中的AUC相当，分别为0.63和0.64。在验证队列中，预测非前哨淋巴结转移风险超过30%的敏感性和特异性分别为0.36和0.81。孤立肿瘤细胞患者模型的AUC从原始队列中的0.73降至验证队列中的0.60。根据存在的风险因素数量将孤立肿瘤细胞患者分为非前哨淋巴结转移的高风险和低风险组时，高风险组中有37%发生了非前哨淋巴结转移。使用此切点时，验证队列中的特异性和敏感性分别为0.48和0.88。
在这个独立的数据集中，微转移患者的模型稳健，准确性与原始队列相似，而孤立肿瘤细胞患者的模型准确性较低。这些模型可用于识别仍应考虑行腋窝淋巴结清扫术的患者。
