Department of Breast Surgery, Copenhagen University Hospital, Afsnit 4124, Blegdamsvej 9, 2100 Copenhagen, Denmark.
Breast Surgery Unit, Helsinki University Central Hospital, P.O. Box 140, 00029 HUS, Helsinki, Finland.
Eur J Surg Oncol. 2014 Apr;40(4):435-41. doi: 10.1016/j.ejso.2014.01.014. Epub 2014 Feb 1.
We cross-validated three existing models for the prediction of non-sentinel node metastases in patients with micrometastases or isolated tumor cells (ITC) in the sentinel node, developed in Danish and Finnish cohorts of breast cancer patients, to find the best model to identify patients who might benefit from further axillary treatment.
Based on 484 Finnish breast cancer patients with micrometastases or ITC in sentinel node a model has been developed for the prediction of non-sentinel node metastases. Likewise, two separate models have been developed in 1577 Danish patients with micrometastases and 304 Danish patients with ITC, respectively. The models were cross-validated in the opposite cohort.
The Danish model for micrometatases was accurate when tested in the Finnish cohort, with a slight change in AUC from 0.64 to 0.63. The AUC of the Finnish model decreased from 0.68 to 0.58 when tested in the Danish cohort, and the AUC of the Danish model for ITC decreased from 0.73 to 0.52, when tested in the Finnish cohort. The Danish micrometastatic model identified 14-22% of the patients as high-risk patients with over 30% risk of non-sentinel node metastases while less than 1% was identified by the Finish model. In contrast, the Finish model predicted a much larger proportion of patients being in the low-risk group with less than 10% risk of non-sentinel node metastases.
The Danish model for micrometastases worked well in predicting high risk of non-sentinel node metastases and was accurate under external validation.
我们对丹麦和芬兰乳腺癌患者队列中开发的三种用于预测前哨淋巴结微转移或孤立肿瘤细胞（ITC）患者非前哨淋巴结转移的现有模型进行了交叉验证，以找到最佳模型来识别可能受益于进一步腋窝治疗的患者。
基于 484 例芬兰前哨淋巴结微转移或 ITC 的乳腺癌患者，建立了用于预测非前哨淋巴结转移的模型。同样，在 1577 例丹麦微转移患者和 304 例丹麦 ITC 患者中分别建立了两个单独的模型，分别在相反的队列中进行了交叉验证。
丹麦微转移模型在芬兰队列中测试时准确率较高，AUC 略有变化，从 0.64 变为 0.63。芬兰模型在丹麦队列中测试时，AUC 从 0.68 下降到 0.58，丹麦 ITC 模型在芬兰队列中测试时，AUC 从 0.73 下降到 0.52。丹麦微转移模型将 14-22%的患者识别为高危患者，非前哨淋巴结转移的风险超过 30%，而芬兰模型仅识别不到 1%的患者为高危患者。相比之下，芬兰模型预测有更大比例的患者属于低风险组，非前哨淋巴结转移的风险小于 10%。
丹麦微转移模型在预测非前哨淋巴结转移的高风险方面表现良好，在外部验证中具有准确性。
