使用列线图预测前哨淋巴结阳性后的非前哨淋巴结转移

Prediction of Non-sentinel Lymph Node Metastases After Positive Sentinel Lymph Nodes Using Nomograms.

作者信息

Gruber Ines, Henzel Maja, Schönfisch Birgitt, Stäbler Annette, Taran Florin-Andrei, Hahn Markus, Röhm Carmen, Helms Gisela, Oberlechner Ernst, Wiesinger Benjamin, Nikolaou Konstantin, LA Fougère Christian, Wallwiener Diethelm, Hartkopf Andreas, Krawczyk Natalia, Fehm Tanja, Brucker Sara

机构信息

Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany

Department of Obstetrics and Gynecology, Filder Clinic, Filderstadt-Bonlanden, Germany.

出版信息

Anticancer Res. 2018 Jul;38(7):4047-4056. doi: 10.21873/anticanres.12694.

DOI:10.21873/anticanres.12694

PMID:29970530

Abstract

BACKGROUND/AIM: Only 30-50% of patients with sentinel lymph node (SLN) metastases present with further axillary lymph node metastases. Therefore, up to 70% of patients with positive SLN are overtreated by axillary dissection (AD) and may suffer from complications such as sensory disturbances or lymphedema. According to the current S3 guidelines, AD can be avoided in patients with a T1/T2 tumor if breast-conserving surgery with subsequent tangential irradiation is performed and no more than two SLNs are affected. Additionally, use of nomograms, that predict the probability of non-sentinel lymph node (NSLN) metastases, is recommended. Therefore, models for the prediction of NSLN metastases in our defined population were constructed and compared with the published nomograms.

PATIENTS AND METHODS

In a retrospective study, 2,146 primary breast cancer patients, who underwent SLN biopsy at the University Women's Hospital in Tuebingen, were evaluated by dividing the patient group in a training and validation collective (TC or VC). Using the SLN-positive TC patients, three models for the prediction of the likelihood of NSLN metastases were adapted and were then validated using the SLN-positive VC patients. In addition, the predictive power of nomograms from Memorial Sloan Kettering Cancer Center (MSKCC), Stanford, and the Cambridge model were compared with regard to our patient collective.

RESULTS

A total of 2,146 patients were included in the study. Of these, 470 patients had positive SLN, 295 consisted the training collective and 175 consisted the validation collective. In a regression model, three variants - with 11, 6 and 2 variables - were developed for the prediction of NSLN metastases in our defined population and compared to the most frequently used nomograms. Our variants with 11 and with 6 variables were proven to be a particularly suitable model and showed similarly good results as the published MSKCC nomogram.

CONCLUSION

Our developed nomograms may be used as a prediction tool for NSLN metastases after positive SLN.

摘要

背景/目的：前哨淋巴结（SLN）转移的患者中只有30%-50%会出现进一步的腋窝淋巴结转移。因此，高达70%的SLN阳性患者接受腋窝清扫术（AD）属于过度治疗，可能会出现感觉障碍或淋巴水肿等并发症。根据当前的S3指南，如果进行保乳手术并随后进行切线照射，且受累的SLN不超过两个，T1/T2肿瘤患者可避免进行AD。此外，建议使用预测非前哨淋巴结（NSLN）转移概率的列线图。因此，构建了我们定义人群中NSLN转移的预测模型，并与已发表的列线图进行比较。

患者与方法

在一项回顾性研究中，对在图宾根大学妇女医院接受SLN活检的2146例原发性乳腺癌患者进行评估，将患者组分为训练集和验证集（TC或VC）。使用SLN阳性的TC患者，采用三种预测NSLN转移可能性的模型，然后使用SLN阳性的VC患者进行验证。此外，还比较了纪念斯隆凯特琳癌症中心（MSKCC）、斯坦福大学和剑桥模型的列线图对我们患者群体的预测能力。

结果

本研究共纳入2146例患者。其中，470例患者SLN阳性，295例组成训练集，175例组成验证集。在一个回归模型中，开发了三个变体——分别有11个、6个和2个变量——用于预测我们定义人群中的NSLN转移，并与最常用的列线图进行比较。我们的11变量和6变量变体被证明是特别合适的模型，并且显示出与已发表的MSKCC列线图相似的良好结果。