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基于超声和临床病理特征预测 HR 状态不同的 HER2 阳性乳腺癌复发的列线图。

Nomograms for predicting recurrence of HER2-positive breast cancer with different HR status based on ultrasound and clinicopathological characteristics.

机构信息

Department of Abdominal Ultrasound, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.

Department of Ultrasound Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.

出版信息

Cancer Med. 2024 Sep;13(17):e70146. doi: 10.1002/cam4.70146.

DOI:10.1002/cam4.70146
PMID:39248049
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11381954/
Abstract

PURPOSE

This study aimed to identify ultrasound and clinicopathological characteristics related to recurrence in HER2-positive (HER2+) breast cancer, and to develop nomograms for predicting recurrence.

METHODS

In this dual-center study, we retrospectively enrolled 570 patients with HER2+ breast cancer. The ultrasound and clinicopathological characteristics of hormone receptor (HR)-/HER2+ patients and HR+/HER2+ patients were analyzed separately according to HR status. Eighty percent of the original samples from HR-/HER2+ and HR+/HER2+ patients were extracted by bootstrap sampling as the training cohorts, while the remaining 20% were used as the external validation cohorts. Informative characteristics were screened through univariate and multivariable Cox regression in the training cohorts and used to develop nomograms for predicting recurrence. The predictive accuracy was calculated using Harrell's C-index and calibration curves.

RESULTS

Three informative characteristics (axillary nodal status, calcification, and Adler degree) were identified in HR-/HER2+ patients, and another three (histological grade, axillary nodal status, and echogenic halo) in HR+/HER2+ patients. Based on these, two separate nomograms were constructed to assess recurrence risk. In the training cohorts, the C-index was 0.740 (95% CI: 0.667-0.811) for HR-/HER2+ nomogram, and 0.749 (95% CI: 0.679-0.820) for HR+/HER2+ nomogram. In the validation cohorts, the C-index was 0.708 (95% CI: 0.540-0.877) for HR-/HER2+ group, and 0.705 (95% CI: 0.557-0.853) for HR+/HER2+ group. The calibration curves also indicated the excellent accuracy of the nomograms.

CONCLUSIONS

Ultrasound performance of HER2+ breast cancers with different HR status was significantly different. Nomograms integrating ultrasound and clinicopathological characteristics exhibited favorable performance and have the potential to serve as a reliable method for predicting recurrence in heterogeneous breast cancer.

摘要

目的

本研究旨在确定与 HER2 阳性（HER2+）乳腺癌复发相关的超声和临床病理特征，并建立预测复发的列线图。

方法

在这项双中心研究中，我们回顾性纳入了 570 例 HER2+乳腺癌患者。根据激素受体（HR）状态，分别分析 HR-/HER2+和 HR+/HER2+患者的超声和临床病理特征。通过 bootstrap 抽样从 HR-/HER2+和 HR+/HER2+患者的原始样本中提取 80%作为训练队列，其余 20%作为外部验证队列。在训练队列中，通过单因素和多因素 Cox 回归筛选出有意义的特征，并用于建立预测复发的列线图。通过 Harrell's C 指数和校准曲线来计算预测准确性。

结果

在 HR-/HER2+患者中，确定了 3 个有意义的特征（腋窝淋巴结状态、钙化和 Adler 分级），在 HR+/HER2+患者中，确定了另外 3 个特征（组织学分级、腋窝淋巴结状态和回声晕）。基于这些特征，分别构建了两个列线图来评估复发风险。在训练队列中，HR-/HER2+列线图的 C 指数为 0.740（95%CI：0.667-0.811），HR+/HER2+列线图的 C 指数为 0.749（95%CI：0.679-0.820）。在验证队列中，HR-/HER2+组的 C 指数为 0.708（95%CI：0.540-0.877），HR+/HER2+组的 C 指数为 0.705（95%CI：0.557-0.853）。校准曲线也表明列线图具有良好的准确性。

结论

不同 HR 状态的 HER2+乳腺癌的超声表现存在显著差异。整合超声和临床病理特征的列线图表现出良好的性能，有可能成为预测异质性乳腺癌复发的可靠方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/970e/11381954/f331a918d4d3/CAM4-13-e70146-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/970e/11381954/d005bb15e353/CAM4-13-e70146-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/970e/11381954/38fc8d51e54a/CAM4-13-e70146-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/970e/11381954/58dec4c97be7/CAM4-13-e70146-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/970e/11381954/52f09ab618c1/CAM4-13-e70146-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/970e/11381954/c1b92727550d/CAM4-13-e70146-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/970e/11381954/0e3dd800483b/CAM4-13-e70146-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/970e/11381954/f331a918d4d3/CAM4-13-e70146-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/970e/11381954/d005bb15e353/CAM4-13-e70146-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/970e/11381954/38fc8d51e54a/CAM4-13-e70146-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/970e/11381954/58dec4c97be7/CAM4-13-e70146-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/970e/11381954/52f09ab618c1/CAM4-13-e70146-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/970e/11381954/c1b92727550d/CAM4-13-e70146-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/970e/11381954/0e3dd800483b/CAM4-13-e70146-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/970e/11381954/f331a918d4d3/CAM4-13-e70146-g006.jpg

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