| 摘要: |
| 目的：探讨三阴性乳腺癌(TNBC)并发腋窝淋巴结转移的危险因素,并基于超声造影参数构建TNBC并发腋窝淋巴结转移的列线图模型。方法：回顾性分析2020年1月至2022年6月在我院治疗165例TNBC患者的临床资料,根据患者腋窝淋巴结转移发生情况将其分为转移组和非转移组。采用多因素Logistic回归分析法筛选TNBC并发腋窝淋巴结转移的危险因素,运用R软件建立预测TNBC并发腋窝淋巴结转移的列线图模型,并验证模型效能。结果：165例TNBC患者中,腋窝淋巴结转移发生率为26.67%(44/165)。转移组和非转移组患者年龄、居住地、文化程度、月经状态、体质量指数、乳腺癌家族史、肿瘤位置、脉管浸润、增强速率(V1)、曲线下面积(TIC-AUC)对比,差异无统计学意义(P>0.05),而肿瘤直径、组织学分级、增殖指数(Ki-67)、超声造影始增时间(IT)、达峰时间(TTP)、峰值强度(PI)对比,差异具有统计学意义(P<0.05)；多因素Logistic回归分析结果显示,肿瘤直径>2cm、组织学分级为Ⅲ级、Ki-67>14%、PI是TNBC并发腋窝淋巴结转移的危险因素,而IT和TTP是TNBC并发腋窝淋巴结转移的保护因素(P<0.05)。TNBC并发腋窝淋巴结转移的列线图模型C-index为0.960(95%CI：0.946~0.974)；校正曲线的预测值和实际值基本吻合；模型的ROC曲线下面积是0.940(95%CI：0.927~0.953)；决策曲线显示阈值概率为1%~100%时,列线图预测TNBC并发腋窝淋巴结转移的净获益值较高。结论：肿瘤直径、组织学分级、Ki-67、IT、TTP、PI等均是TNBC并发腋窝淋巴结转移的影响因素,基于超声造影参数构建的TNBC并发腋窝淋巴结转移的列线图模型具有较高的临床应用价值。 |
| 关键词: 超声造影参数 三阴性乳腺癌 腋窝淋巴结转移 危险因素 列线图 |
| DOI： |
| 投稿时间：2024-04-18修订日期：2024-06-03 |
| 基金项目: |
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| Construction of a risk prediction model for axillary lymph node metastasis in triple negative breast cancer patients based on contrast-enhanced ultrasound |
| zhangyi,xuhaifeng,fanxiaowei |
| () |
| Abstract: |
| Objective: To investigate the risk factors of triple negative breast cancer (TNBC) complicated with axillary lymph node metastasis, and predict the parameters of contrast-enhanced ultrasound (CEUS) to construct a neographic model of TNBC complicated with axillary lymph node metastasis. Methods: The clinical data of 165 patients with TNBC treated in our hospital from January 2020 to June 2022 were retrospectively analyzed, and the patients were divided into metastatic group and non-metastatic group according to the occurrence of axillary lymph node metastasis. Multivariate Logistic regression analysis was used to screen the risk factors of TNBC complicated with axillary lymph node metastasis. R software was used to establish a nomogram model for predicting TNBC complicated with axillary lymph node metastasis, and the effectiveness of the model was verified.Results: Among 165 patients with TNBC, the incidence of axillary lymph node metastasis was 26.67% (44/165). There was no significant difference in age, residence, education, menstrual status, body mass index, family history of breast cancer, tumor location, vascular invasion, enhancement rate (V1), and area under the curve (TIC-AUC) between metastatic and non-metastatic groups (P>0.05). There were significant differences in tumor diameter, histological grade, proliferation index (Ki-67), contrast-enhanced ultrasound onset time (IT), peak time (TTP) and peak intensity (PI) (P<0.05). Multivariate Logistic regression analysis showed that the tumor diameter >2cm, histological grade Ⅲ, Ki-67>14% and PI were risk factors for axillary lymph node metastasis complicated by TNBC, while IT and TTP were protective factors for axillary lymph node metastasis complicated by TNBC (P<0.05). The C-index of the nomogram model of TNBC complicated with axillary lymph node metastasis was 0.960 (95%CI: 0.946~0.974). The predicted value of the correction curve is basically consistent with the actual value. The area under ROC curve of the model was 0.940 (95%CI: 0.927~0.953). When the decision curve showed a threshold probability of 1%-100%, the net benefit value of TNBC with axillary lymph node metastasis predicted by the nomogram was higher.Conclusion: Tumor diameter, histological grade, Ki-67, IT, TTP, PI, etc. are all influencing factors of axillary lymph node metastasis complicated by TNBC. The nomogram model of TNBC complicated by axillary lymph node metastasis constructed based on contrast-enhanced ultrasound parameters has high clinical application value. |
| Key words: Contrast-enhanced ultrasound parameters Triple negative breast cancer Axillary lymph node metastasis Risk factors nomograph |
