基于 SEER 数据库的乳腺癌不同淋巴结状态的新型列线图和生存分析。

INTRODUCTION: The axillary lymph node status (ALNS) and internal mammary lymph nodes (IMLN) expression associated with breast cancer are closely linked to prognosis. This study aimed to establish a nomogram to predict survival at 3, 5, and 10 years in patients with various lymph node statuses. METHODS: We obtained data from patients with breast cancer between 2004 and 2015 from the Surveillance, Epidemiology, and End Results (SEER database). Chi-square analysis was performed to test for differences in the pathological characteristics of the groups, and Kaplan-Meier analysis and the log-rank test were used to plot and compare the correlation between overall survival (OS) and breast cancer specific survival (BCSS). The log-rank test was used for the univariate analysis, and statistically significant characteristics were included in the multivariate and Cox regression analyses. Finally, Independent factor identification was included in constructing the nomogram using R studio 4.2.0; area under curve (AUC) values were calculated, and receiver operating characteristic (ROC) curve, calibration, and decision curve analysis (DCA) curves were plotted for evaluation. RESULTS: A total of 279,078 patients were enrolled and analysed, demonstrating that the isolated tumour cells (ITC) group had clinicopathological characteristics similar to those of micrometastases (Mic). Multivariate analysis was performed to identify each subgroup's independent risk factors and construct a nomogram. The AUC values were 74.7 (95% CI 73.6-75.8), 72.8 (95% CI 71.9-73.8), and 71.2 (95% CI 70.2-72.2) for 3-, 5-, and 10-year OS, respectively, and 82.2 (95% CI 80.9-83.6), 80.1 (95% CI 79.0-81.2), and 75.5 (95% CI 74.3-76.8) for BCSS in overall breast cancer cases, respectively. AUC values for 3-, 5-, and 10-year OS in the ITC group were 64.8 (95% CI 56.5-73.2), 67.7 (95% CI 62.0-73.4), and 65.4 (95% CI 60.0-70.7), respectively. For those in the Mic group, AUC values for 3-, 5-, and 10-year OS were 72.9 (95% CI 70.7-75.1), 72.4 (95% CI 70.6-74.1), and 71.3 (95% CI 69.6-73.1), respectively, and AUC values for BCSS were 77.8 (95% CI 74.9-80.7), 75.7 (95% CI 73.5-77.9), and 70.3 (95% CI 68.0-72.6), respectively. In the IMLN group, AUC values for 3-, 5-, and 10-year OS were 75.2 (95% CI 71.7-78.7), 73.4 (95% CI 70.0-76.8), and 74.0 (95% CI 69.6-78.5), respectively, and AUC values for BCSS were 76.6 (95% CI 73.0-80.3), 74.1 (95% CI 70.5-77.7), and 74.7 (95% CI 69.8-79.5), respectively. The ROC, calibration, and DCA curves verified that the nomogram had better predictability and benefits. CONCLUSION: This study is the first to investigate the predictive value of different axillary lymph node statuses and internal mammary lymph node metastases in breast cancer, providing clinicians with additional aid in treatment decisions.

简介：乳腺癌的腋窝淋巴结状态（ALNS）和内乳淋巴结（IMLN）表达与预后密切相关。本研究旨在建立一个列线图，以预测不同淋巴结状态患者的 3、5 和 10 年生存率。

方法：我们从 2004 年至 2015 年的 SEER 数据库中获取了乳腺癌患者的数据。使用卡方分析检验组间病理特征的差异，使用 Kaplan-Meier 分析和对数秩检验绘制和比较总生存（OS）和乳腺癌特异性生存（BCSS）之间的相关性。对数秩检验用于单因素分析，有统计学意义的特征被纳入多因素和 Cox 回归分析。最后，使用 R studio 4.2.0 中的独立因素识别来构建列线图；计算曲线下面积（AUC）值，并绘制接受者操作特征（ROC）曲线、校准曲线和决策曲线分析（DCA）曲线进行评估。

结果：共纳入 279078 例患者进行分析，结果表明孤立肿瘤细胞（ITC）组的临床病理特征与微转移（Mic）组相似。通过多因素分析确定了每个亚组的独立危险因素，并构建了列线图。3 年、5 年和 10 年 OS 的 AUC 值分别为 74.7（95%CI 73.6-75.8）、72.8（95%CI 71.9-73.8）和 71.2（95%CI 70.2-72.2），总体乳腺癌患者的 82.2（95%CI 80.9-83.6）、80.1（95%CI 79.0-81.2）和 75.5（95%CI 74.3-76.8），以及 ITC 组 3 年、5 年和 10 年 OS 的 AUC 值分别为 64.8（95%CI 56.5-73.2）、67.7（95%CI 62.0-73.4）和 65.4（95%CI 60.0-70.7），Mic 组 3 年、5 年和 10 年 OS 的 AUC 值分别为 72.9（95%CI 70.7-75.1）、72.4（95%CI 70.6-74.1）和 71.3（95%CI 69.6-73.1），BCSS 的 AUC 值分别为 77.8（95%CI 74.9-80.7）、75.7（95%CI 73.5-77.9）和 70.3（95%CI 68.0-72.6），IMLN 组 3 年、5 年和 10 年 OS 的 AUC 值分别为 75.2（95%CI 71.7-78.7）、73.4（95%CI 70.0-76.8）和 74.0（95%CI 69.6-78.5），BCSS 的 AUC 值分别为 76.6（95%CI 73.0-80.3）、74.1（95%CI 70.5-77.7）和 74.7（95%CI 69.8-79.5）。ROC、校准和 DCA 曲线验证了该列线图具有更好的预测能力和获益。

结论：本研究首次探讨了不同腋窝淋巴结状态和内乳淋巴结转移对乳腺癌的预测价值，为临床医生在治疗决策中提供了额外的辅助。