乳腺癌新辅助化疗后腋窝淋巴结病理学完全缓解预测模型的验证与改良研究

doi:10.19401/j.cnki.1007-3639.2019.06.008

中国癌症杂志 ›› 2019, Vol. 29 ›› Issue (6): 445-451.doi: 10.19401/j.cnki.1007-3639.2019.06.008

乳腺癌新辅助化疗后腋窝淋巴结病理学完全缓解预测模型的验证与改良研究

郑卫真^1,2，孙菊杰³，刘雁冰²，邱鹏飞²，毕　钊^1,2，赵　桐²，王永胜²

1. 济南大学山东省医学科学院医学与生命科学学院，山东济南 250062 ；
2. 山东大学附属山东省肿瘤医院乳腺病中心外科三病区，山东济南 250117 ；
3. 山东大学附属山东省肿瘤医院病理科，山东济南 250117

出版日期:2019-06-30 发布日期:2019-07-12
通信作者: 王永胜 E-mail: wangysh2008@aliyun.com

Validation and modification study of axillary node pathologic complete response predictive model after neoadjuvant chemotherapy for breast cancer

ZHENG Weizhen^1,2, SUN Jujie³, LIU Yanbing², QIU Pengfei², BI Zhao^1,2, ZHAO Tong², WANG Yongsheng²

1. School of Medicine and Life Sciences, University of Jinan and Shandong Academy of Medical Sciences, Jinan 250062, Shandong Province, China; 2. Surgical Ward 3, Breast Cancer Center, Shandong Cancer Hospital Affiliated to Shandong University, Jinan 250117, Shandong Province, China; 3. Department of Pathology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan 250117, Shandong Province, China

Published:2019-06-30 Online:2019-07-12
Contact: WANG Yongsheng E-mail: wangysh2008@aliyun.com

摘要/Abstract

摘要： 背景与目的：新辅助化疗（neoadjuvant chemotherapy，NAC）是局部晚期乳腺癌患者的标准治疗模式，2018年有研究报道了一个多变量预测模型，用于预测临床腋窝淋巴结阳性（clinical lymph node-positive，cN₊）患者NAC后腋淋巴结病理完全缓解（ypN₀）的概率。分析乳腺癌NAC后ypN₀的相关因素，验证Olga Kantor预测模型的临床应用价值。方法：纳入山东大学附属山东省肿瘤医院2014年4月—2018年5月收治的350例临床腋淋巴结阳性NAC后行腋窝淋巴结清扫术（axillary lymph node dissection，ALND）的患者，并进行Olga Kantor预测模型的验证；由于该模型采用术后病理学评估乳腺原发肿瘤反应无助于术前预测ypN₀，因此采用术前影像评价替代术后病理学评估进行改良，分别分析验证模型和改良模型的独立预测因素，计算受试者工作特征（receiver operating characteristic，ROC）曲线的曲线下面积（area under curve，AUC）评估两模型的预测效能。结果：验证模型中年龄、分型分组及病理乳房原发肿瘤反应为ypN0的独立预测指标，改良模型中年龄、分型分组及临床乳房原发肿瘤反应为ypN₀的独立预测指标（P均＜0.05）。验证模型及改良模型的AUC分别为0.788和0.782（P>0.05）。改良模型分数≤3分、4~7分及≥8分患者NAC后ypN₀概率分别为2.5%（1/40）、22.4%（51/228）和68.3%（56/82）。结论：Olga Kantor预测模型可以较为准确地评估cN+患者ypN₀概率，改良模型具有同等的预测效能且更贴合临床实际，有助于NAC后腋窝处理模式的合理选择：得分≤3分推荐直接行ALND，4~7分可选择前哨淋巴结活检（sentinel lymph node biopsy，SLNB），≥8分推荐行SLNB。

关键词: 乳腺癌, 新辅助化疗, 腋窝淋巴结病理完全缓解, 预测, 前哨淋巴结活检

Abstract: Background and purpose: Neoadjuvant chemotherapy (NAC) has become the standard treatment method for locally advanced breast cancer. In 2018, researchers established a multivariate predictive model for predicting the probability of axillary complete response (ypN₀) after NAC in patients with clinical axillary lymph node positive (cN₊) disease. This study aimed to evaluate the related factors of ypN₀ after NAC, and to verify and modify the Olga Kantor predictive model for breast cancer patients. Methods: A total of 350 consecutive node-positive breast cancer patients who received axillary lymph node dissection (ALND) after NAC in Shandong Cancer Hospital Affiliated to Shandong University were retrospectively analyzed. As the pathological evaluation of the primary breast tumor response in the Olga Kantor model could not be used for preoperative prediction of ypN₀, preoperative image after NAC was incorporated in our study as a surrogate to modify this model. Independent predictive factors were analyzed both in the validation model and the modification model, and the predictive accuracy was assessed by the area under receiver operating characteristic (ROC) curve (AUC) in the two models. Results: Age, molecular subtype, Ki-67 and pathological extent of breast tumor response were independent predictors of ypN₀ in the validation model, while age, molecular subtype and clinical extent of breast tumor response were independent predictors in the modification model (P<0.05, respectively). The validation and modification models achieved the AUC of 0.788 and 0.782, respectively (P>0.05). In the modification model, patients with predictive score ≤3, 4-7 and ≥8 reached ypN0 rates of 2.5% (1/40), 22.4% (51/228) and 68.3% (56/82), respectively. Conclusion: Olga Kantor model could accurately predict ypN₀ after NAC, and our modification model could reach the same predictive power but was more in line with clinical practice, which could provide a reasonable support for patient selection for sentinel lymph node biopsy (SLNB) after NAC. ALND is suggested in patients with score ≤3, SLNB is suitable for patients with score 4-7, and SLNB is recommended to patients with score ≥8.

Key words: Breast cancer, Neoadjuvant chemotherapy, Axillary lymph node pathologic complete response, Prediction, Sentinel lymph node biopsy

郑卫真，孙菊杰，刘雁冰，邱鹏飞，毕　钊，赵　桐，王永胜. 乳腺癌新辅助化疗后腋窝淋巴结病理学完全缓解预测模型的验证与改良研究[J]. 中国癌症杂志, 2019, 29(6): 445-451.

ZHENG Weizhen, SUN Jujie, LIU Yanbing, QIU Pengfei, BI Zhao, ZHAO Tong, WANG Yongsheng. Validation and modification study of axillary node pathologic complete response predictive model after neoadjuvant chemotherapy for breast cancer[J]. China Oncology, 2019, 29(6): 445-451.

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乳腺癌新辅助化疗后腋窝淋巴结病理学完全缓解预测模型的验证与改良研究

Validation and modification study of axillary node pathologic complete response predictive model after neoadjuvant chemotherapy for breast cancer

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