Wang Yang, Zhao Yuanyuan, Liu Song, Tang Weifang, Gao Hong, Zheng Xucai, Hong Shikai, Wang Shengying
Department of Head-Neck and Breast Surgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Anhui Provincial Cancer Hospital, Hefei Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Collaborative Innovation Center of Cancer Medicine, Fudan University Shanghai Cancer Center Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Medicine (Baltimore). 2017 Oct;96(42):e8203. doi: 10.1097/MD.0000000000008203.
We aimed to investigate the prognostic value of postpathological characters in nonmetastatic breast cancer (NMBC) patients who received preoperative radiotherapy (PRT) followed by mastectomy (MAST).We conducted retrospective analyses using the data collected from the Surveillance, Epidemiology, and End Results program of the National Cancer Institute. Univariate and multivariate analyses were performed to identify prognostic factors. Disease-specific survival was calculated by the Kaplan-Meier curve and validated by log rank test. The discriminations of independent risk factors and staging systems were compared by the area under receiver operating characteristic curves (AUC) and validated by Harrell concordance index (bootstrapping algorithm). Akaike information criterion (AIC) was applied to compare the difference of model.One thousand three hundred fifty NMBC patients who had received PRT followed by MAST from 1988 to 2013 were included in the study. We found the metastatic lymph node ratio (mLNR) staging was a superior indicator than pN staging. Thus, we proposed a T-lymph node ratio (T-NR) staging system with simplified-T categories (T0-3 and T4) and the mLNR staging. The novel T-NR staging system provided larger AUC (P = .024, .008, respectively) and the smaller AIC (P < .001) value than American Joint Committee on Cancer staging system.The novel T-NR staging system performed more accurate survival prediction and better model fitness for NMBC patients who receive PRT followed by MAST, it may provide a wide applicability in clinical decision-making.
我们旨在研究术前放疗（PRT）后行乳房切除术（MAST）的非转移性乳腺癌（NMBC）患者病理特征的预后价值。我们使用从美国国立癌症研究所监测、流行病学和最终结果计划收集的数据进行回顾性分析。进行单因素和多因素分析以确定预后因素。通过Kaplan-Meier曲线计算疾病特异性生存率，并通过对数秩检验进行验证。通过受试者操作特征曲线（AUC）下面积比较独立危险因素和分期系统的辨别能力，并通过Harrell一致性指数（自举算法）进行验证。应用赤池信息准则（AIC）比较模型差异。本研究纳入了1988年至2013年间1350例接受PRT后行MAST的NMBC患者。我们发现转移淋巴结比率（mLNR）分期是比pN分期更好的指标。因此，我们提出了一种T淋巴细胞比率（T-NR）分期系统，该系统具有简化的T分类（T0-3和T4）和mLNR分期。与美国癌症联合委员会分期系统相比，新型T-NR分期系统提供了更大的AUC（分别为P = 0.024、0.008）和更小的AIC（P < 0.001）值。新型T-NR分期系统对接受PRT后行MAST的NMBC患者的生存预测更准确，模型拟合度更好，可能在临床决策中具有广泛的适用性。
