He Lifang, Liang Peide, Zeng Huancheng, Huang Guangsheng, Wu Jundong, Zhang Yiwen, Cui Yukun, Huang Wenhe
Breast Center, Cancer Hospital of Shantou University Medical College, Shantou 515000, Guangdong Province, China.
Guangdong Provincial Key Laboratory for Breast Cancer Diagnosis and Treatment, Cancer Hospital of Shantou University Medical College, Shantou 515000, Guangdong Province, China.
J Oncol. 2022 Feb 24;2022:7704686. doi: 10.1155/2022/7704686. eCollection 2022.
Axial lymph node dissection (ALND) is needed in patients with positive sentinel lymph node (SLN). ALND is easy to cause upper limb edema. Therefore, accurate prediction of nonsentinel lymph nodes (non-SLN) which may not need ALND can avoid excessive dissection and reduce complications. We constructed a new prognostic model to predict the non-SLN metastasis of Chinese breast cancer patients.
We enrolled 736 patients who underwent sentinel lymph node biopsy (SLNB); 228 (30.98%) were diagnosed with SLNB metastasis which was determined by intraoperative pathological detection and further accepted ALND. We constructed a prediction model by univariate analysis, multivariate analysis, "R" language, and binary logistic regression in the abovementioned 228 patients and verified this prediction model in 60 patients.
Based on univariate analysis using = 0.05 as the significance level for type I error, we found that age (=0.045), tumor size (=0.006), multifocality (=0.011), lymphovascular invasion (=0.003), positive SLN number (=0.009), and negative SLN number (=0.034) were statistically significant. Age was excluded in multivariate analysis, and we constructed a predictive equation to assess the risk of non-SLN metastasis: Logit()=Ln(/1 - )=0.267+1.443+1.078+0.471 - 0.618 - 2.541 (where "" represents tumor size, "" represents multifocality, "" represents lymphovascular invasion, "" represents the number of metastasis of SLN, and "" represents the number of SLNs without metastasis). AUCs for the training group and validation group were 0.715 and 0.744, respectively. When setting the risk value below 22.3%, as per the prediction equation's low-risk interval, our model predicted that about 4% of patients could avoid ALND.
This study established a model which demonstrated good prognostic performance in assessing the risk of non-SLN metastasis in Chinese patients with positive SLNs.
前哨淋巴结（SLN）阳性的患者需要进行腋窝淋巴结清扫术（ALND）。ALND容易导致上肢水肿。因此，准确预测可能不需要进行ALND的非前哨淋巴结（non-SLN）可以避免过度清扫并减少并发症。我们构建了一种新的预后模型来预测中国乳腺癌患者的non-SLN转移情况。
我们纳入了736例行前哨淋巴结活检（SLNB）的患者；其中228例（30.98%）经术中病理检测确诊为SLNB转移，并进一步接受了ALND。我们在上述228例患者中通过单因素分析、多因素分析、“R”语言和二元逻辑回归构建了一个预测模型，并在60例患者中对该预测模型进行了验证。
以I类错误的显著性水平α=0.05进行单因素分析，我们发现年龄（P=0.045）、肿瘤大小（P=0.006）、多灶性（P=0.011）、淋巴管侵犯（P=0.003）、转移的SLN数量（P=0.009）和未转移的SLN数量（P=0.034）具有统计学意义。多因素分析中排除了年龄因素，我们构建了一个预测方程来评估non-SLN转移风险：Logit(P)=Ln(P/1 - P)=0.267+1.443×肿瘤大小+1.078×多灶性+0.471×淋巴管侵犯 - 0.618×转移的SLN数量 - 2.541×未转移的SLN数量（其中“肿瘤大小”代表肿瘤大小，“多灶性”代表多灶性，“淋巴管侵犯”代表淋巴管侵犯，“转移的SLN数量”代表转移的SLN数量，“未转移的SLN数量”代表未转移的SLN数量）。训练组和验证组的曲线下面积（AUC）分别为0.715和0.744。根据预测方程的低风险区间，当将风险值设定在22.3%以下时，我们的模型预测约4%的患者可以避免进行ALND。
本研究建立了一个在评估中国SLN阳性患者的non-SLN转移风险方面具有良好预后性能的模型。
Zotero 插件
