Duan Hongtao, Zhang Jiawei, Zhang Guanxin, Zhu Xingmeng, Wang Wenjia
Department of Ultrasound, Wuxi Huishan District People's Hospital, Wuxi, Jiangsu, China.
Department of Ultrasound, Hulunbuir People's Hospital, Hulunbuir, China.
Front Oncol. 2023 Jun 5;13:1196592. doi: 10.3389/fonc.2023.1196592. eCollection 2023.
The rate of breast-conserving surgery is very low in China, compared with that in developed countries; most breast cancer patients receive mastectomy. It is great important to explore the possibility of omitting axillary lymph node dissection (ALND) in early-stage breast cancer patients with 1 or 2 positive sentinel lymph nodes (SLNs) in China. The aim of this study was to develop a nomogram based on elastography for the prediction of the risk of non-SLN (NSLN) metastasis in early-stage breast cancer patients with 1 or 2 positive SLNs.
A total of 601 breast cancer patients were initially recruited. According to the inclusion and exclusion criteria, 118 early-stage breast cancer patients with 1 or 2 positive SLNs were finally enrolled and were assigned to the training cohort (n=82) and the validation cohort (n=36), respectively. In the training cohort, the independent predictors were screened by logistic regression analysis and then were used to conducted the nomogram for the prediction of NSLN metastasis in early-stage breast cancer patients with 1 or 2 positive SLNs. The calibration curves, concordance index (C-index), the area under the receiver operating characteristic (ROC) curve (AUC), and Decision curve analysis (DCA) were used to verified the performance of the nomogram.
The multivariable analysis showed that the enrolled patients with positive HER2 expression (OR=6.179, P=0.013), Ki67≥14% (OR=8.976, P=0.015), larger lesion size (OR=1.038, P=0.045), and higher Emean (OR=2.237, P=0.006) were observed to be the independent factors of NSLN metastasis. Based on the above four independent predictors, a nomogram was conducted to predict the risk of the NSLN metastasis in early-stage breast cancer patients with 1 or 2 positive SLNs. The nomogram showed good discrimination in the prediction of NSLN metastasis, with bias-corrected C-index of 0.855 (95% CI, 0.754-0.956) and 0.853 (95% CI, 0.724-0.983) in the training and validation cohorts, respectively. Furthermore, the AUC was 0.877 (95%CI: 0.776- 0.978) and 0.861 (95%CI: 0.732-0.991), respectively, indicating a good performance of the nomogram. The calibration curve suggested a satisfactory agreement between the predictive and actual risk in both the training (χ2 = 11.484, P=0.176, HL test) and validation (χ2 = 6.247, p = 0.620, HL test) cohorts, and the obvious clinical nets were revealed by DCA.
We conducted a satisfactory nomogram model to evaluate the risk of NSLN metastasis in early-stage breast cancer patients with 1 or 2 SLN metastases. This model could be considered as an ancillary tool to help such patients to be selectively exempted from ALND.
与发达国家相比，中国保乳手术的比例很低；大多数乳腺癌患者接受乳房切除术。在中国，探讨早期乳腺癌患者前哨淋巴结（SLN）1或2枚阳性时省略腋窝淋巴结清扫（ALND）的可能性非常重要。本研究的目的是基于弹性成像技术开发一种列线图，用于预测早期乳腺癌患者前哨淋巴结1或2枚阳性时非前哨淋巴结（NSLN）转移的风险。
最初共招募601例乳腺癌患者。根据纳入和排除标准，最终纳入118例前哨淋巴结1或2枚阳性的早期乳腺癌患者，并分别分配至训练队列（n = 82）和验证队列（n = 36）。在训练队列中，通过逻辑回归分析筛选独立预测因素，然后用于构建预测前哨淋巴结1或2枚阳性的早期乳腺癌患者NSLN转移风险的列线图。采用校准曲线、一致性指数（C指数）、受试者操作特征曲线（ROC）下面积（AUC）和决策曲线分析（DCA）来验证列线图的性能。
多变量分析显示，入组患者中HER2表达阳性（OR = 6.179，P = 0.013）、Ki67≥14%（OR = 8.976，P = 0.015）、肿瘤大小较大（OR = 1.038，P = 0.045）和较高的Emean（OR = 2.237，P = 0.006）是NSLN转移的独立因素。基于上述四个独立预测因素，构建了预测前哨淋巴结1或2枚阳性的早期乳腺癌患者NSLN转移风险的列线图。该列线图在预测NSLN转移方面显示出良好的区分度，训练队列和验证队列中偏差校正C指数分别为0.855（95%CI，0.754 - 0.956）和0.853（95%CI，0.724 - 0.983）。此外，AUC分别为0.877（95%CI：0.776 - 0.978）和0.861（95%CI：0.732 - 0.991），表明列线图性能良好。校准曲线表明训练队列（χ2 = 11.484，P = 0.
