乳腺癌内乳前哨淋巴结活检评估预后及指导个体化内乳照射：一项长期随访研究

doi:10.19401/j.cnki.1007-3639.2023.02.007

中国癌症杂志 ›› 2023, Vol. 33 ›› Issue (2): 142-151.doi: 10.19401/j.cnki.1007-3639.2023.02.007

乳腺癌内乳前哨淋巴结活检评估预后及指导个体化内乳照射：一项长期随访研究

陈玉光¹^,²(), 孙晓², 毕钊¹^,², 邱鹏飞¹^,², 段宝伟¹^,²^,³, 樊庆达¹^,², 王永胜¹^,²()

1.山东第一医科大学（山东省医学科学院）研究生部，山东济南 250118
2.山东省肿瘤防治研究院（山东省肿瘤医院）乳腺病中心，山东第一医科大学（山东省医学科学院），山东济南 250117
3.泰安市肿瘤防治院乳腺外科，山东泰安 271000

收稿日期:2022-11-10 修回日期:2023-02-07 出版日期:2023-02-28 发布日期:2023-03-22
通信作者: 王永胜（ORCID: 0000-0001-6252-684X），博士，主任医师，山东省肿瘤医院乳腺病中心主任。
作者简介:陈玉光（ORCID: 0000-0003-2274-8039），山东第一医科大学硕士研究生。
王永胜，二级教授、博士研究生导师，山东省肿瘤医院乳腺病中心主任。现任中国抗癌协会乳腺癌专业委员会副主任委员，中国抗癌协会国际医疗交流分会副主任委员，中国临床肿瘤学会乳腺癌专家委员会常务委员，中国医师协会肿瘤分会乳腺癌学组副组长，中华医学会肿瘤学分会乳腺癌学组委员，国家卫健委乳腺癌诊疗规范专家组成员，全球乳腺癌大会国际指导专家委员会成员，山东省抗癌协会靶向治疗分会主任委员。于国内率先开展乳腺癌保留乳房手术、前哨淋巴结活检替代腋窝淋巴结清扫术、乳腺病变微创诊断等研究，作为组长单位和首席专家，牵头开展了中国临床早期乳腺癌前哨淋巴结活检替代腋窝清扫术的多中心研究、乳腺癌内乳区前哨淋巴结活检术的多中心前瞻性临床验证研究和新型示踪技术引导乳腺癌内乳前哨淋巴结活检的多中心前瞻性临床研究，研究成果已达到国际领先水平，并参与多项国际和国内乳腺癌Ⅲ期临床研究。以第一作者或通信作者发表论文200余篇，其中在SCI收录期刊上发表论文60余篇，出版专著（译著等）共4部，授权国家发明专利2项，获奖成果共5项，其中国家级1项、部（省）级4项，作为主要负责人承担国家级项目4项、部（省）级项目3项。
基金资助:
国家自然科学基金(81672638);山东省医药卫生科技发展计划基金(2019WS201)

Internal mammary sentinel lymph node biopsy for breast cancer: a long-term follow-up research for assessment of prognosis and guiding individualized internal mammary lymph node irradiation

CHEN Yuguang¹^,²(), SUN Xiao², BI Zhao¹^,², QIU Pengfei¹^,², DUAN Baowei¹^,²^,³, FAN Qingda¹^,², WANG Yongsheng¹^,²()

1. Graduate Department of Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250118, Shandong Province, China
2. Department of Breast Cancer Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, Shandong Province, China
3. Department of Breast Surgery, Taian Tumor Hospital, Taian 271000, Shandong Province, China

Received:2022-11-10 Revised:2023-02-07 Published:2023-02-28 Online:2023-03-22
Contact: WANG Yongsheng

摘要/Abstract

摘要：

背景与目的： 内乳照射（internal mammary lymph node irradiation，IMNI）可以改善内乳淋巴结（internal mammary lymph node，IMLN）高危转移患者的生存。本研究旨在探讨内乳前哨淋巴结活检（internal mammary sentinel lymph node biopsy，IM-SLNB）对评估预后及指导个体化IMNI的优势。方法： 回顾性分析2011年11月—2021年12月在3项前瞻性临床试验（NCT01642511、NCT03541278、NCT03024463）中成功行IM-SLNB的浸润性乳腺癌患者，筛选预后的独立危险因素，分析内乳前哨淋巴结（internal mammary sentinel lymph node，IMSLN）转移对预后的影响；在接受区域淋巴结照射者中分析IMNI实施状况、生存获益及对放射性肺损伤（radiation induced lung injury，RILI）的影响。主要研究终点为无病生存期（disease-free survival，DFS），次要研究终点为总生存期（overall survival，OS）和RILI。结果： 研究入组537例患者，中位随访60个月。IMSLN转移状况是DFS及OS的独立危险因素（P均<0.05），与IMSLN阴性组患者相比，IMSLN阳性组患者DFS及OS显著降低（P均<0.05）。IMSLN阴性患者增加IMNI并没有显著改善DFS（P = 0.099）和OS（P = 0.486），但RILI的风险显著增高（OR = 3.678，P<0.05）。对于IMSLN阳性患者，增加IMNI可显著改善5年DFS（87.3% vs 52.5%，P = 0.040），但并未转化为OS的获益（P = 0.603）。结论： IMSLN的转移状况是独立的预后因素，IMSLN转移的患者接受IMNI可显著改善预后，IMSLN未转移的患者通过豁免IMNI可在不影响预后的情况下显著降低RILI的风险。

关键词: 乳腺癌, 前哨淋巴结活检, 内乳淋巴结, 照射, 预后

Abstract:

Background and purpose: Internal mammary lymph node irradiation (IMNI) improves survival in patients with internal mammary lymph node (IMLN) high-risk metastatic breast cancer. The purpose of this study was to study the advantages of internal mammary sentinel lymph node (IMLN) biopsy (IM-SLNB) for assessing prognosis and directing individualized IMNI. Methods: This study evaluated patients recruited in three prospective clinical trials (NCT01642511, NCT03541278, and NCT03024463) from November 2011 to December 2021, assessed for prognostic risk variables based on IMSLN metastatic status and prognosis between subgroups. In patients who received regional lymph node irradiation, the implementation status, survival benefit, and influence of IMNI on radiation-induced lung injury (RILI) were studied. The primary endpoint was disease-free survival (DFS), with overall survival (OS) and RILI as secondary endpoints. Results: The study enrolled 537 patients and had a 60-month median follow-up. Patients with IMSLN metastasis had a significantly worse 5-year DFS and OS (DFS: 95.1% vs 71.4%, OS: 99.1% vs 90.1%, both P<0.05), and IMSLN metastatic status was an independent risk factor for DFS and OS (both P<0.05). Adding IMNI did not improve DFS (P = 0.099) or OS (P = 0.486) in patients with negative IMSLN, while it did increase the risk of RILI (OR = 3.678, P<0.05). However, adding IMNI improved 5-year DFS (87.3% vs 52.5%, P = 0.040) for patients with positive IMSLN but had no effect on OS (P = 0.603). Conclusion: This study discovered that IMSLN metastatic status has significant prognostic importance. Patients with IMSLN metastasis who receive IMNI have significantly improved prognosis, and patients without IMSLN metastasis have a much lower risk of RILI by being exempt from IMNI without worse prognosis.

Key words: Breast cancer, Sentinel lymph node biopsy, Internal mammary lymph nodes, Irradiation, Prognosis

中图分类号:

R737.9

陈玉光, 孙晓, 毕钊, 邱鹏飞, 段宝伟, 樊庆达, 王永胜. 乳腺癌内乳前哨淋巴结活检评估预后及指导个体化内乳照射：一项长期随访研究[J]. 中国癌症杂志, 2023, 33(2): 142-151.

CHEN Yuguang, SUN Xiao, BI Zhao, QIU Pengfei, DUAN Baowei, FAN Qingda, WANG Yongsheng. Internal mammary sentinel lymph node biopsy for breast cancer: a long-term follow-up research for assessment of prognosis and guiding individualized internal mammary lymph node irradiation[J]. China Oncology, 2023, 33(2): 142-151.

图/表 6

表1

表2

图1

图2

表3

表4

参考文献 21

[1]	WHELAN T J, OLIVOTTO I A, PARULEKAR W R, et al. Regional nodal irradiation in early-stage breast cancer[J]. N Engl J Med, 2015, 373(4): 307-316. doi: 10.1056/NEJMoa1415340
[2]	POORTMANS P M, WELTENS C, FORTPIED C, et al. Internal mammary and medial supraclavicular lymph node chain irradiation in stage Ⅰ-Ⅲ breast cancer (EORTC 22922/10925): 15-year results of a randomised, phase 3 trial[J]. Lancet Oncol, 2020, 21(12): 1602-1610. doi: 10.1016/S1470-2045(20)30472-1
[3]	POORTMANS P M, COLLETTE S, KIRKOVE C, et al. Internal mammary and medial supraclavicular irradiation in breast cancer[J]. N Engl J Med, 2015, 373(4): 317-327. doi: 10.1056/NEJMoa1415369
[4]	THORSEN L B J, OVERGAARD J, MATTHIESSEN L W, et al. Internal mammary node irradiation in patients with node-positive early breast cancer: fifteen-year results from the Danish breast cancer group internal mammary node study[J]. J Clin Oncol, 2022, 40(36): 4198-4206. doi: 10.1200/JCO.22.00044
[5]	HENNEQUIN C, BOSSARD N, SERVAGI-VERNAT S, et al. Ten-year survival results of a randomized trial of irradiation of internal mammary nodes after mastectomy[J]. Int J Radiat Oncol Biol Phys, 2013, 86(5): 860-866. doi: 10.1016/j.ijrobp.2013.03.021
[6]	BUDACH W, KAMMERS K, BOELKE E, et al. Adjuvant radiotherapy of regional lymph nodes in breast cancer - a meta-analysis of randomized trials[J]. Radiat Oncol, 2013, 8: 267. doi: 10.1186/1748-717X-8-267 pmid: 24225206
[7]	CONG B B, CAO X S, CAO L, et al. Internal mammary lymph nodes radiotherapy of breast cancer in the era of individualized medicine[J]. Oncotarget, 2017, 8(46): 81583-81590. doi: 10.18632/oncotarget.v8i46
[8]	QIU P F, WANG X E, WANG Y S. Indications for individual internal mammary node irradiation[J]. Lancet Oncol, 2021, 22(2): e40. doi: 10.1016/S1470-2045(20)30739-7
[9]	邱鹏飞, 王永胜. 前哨淋巴结时代乳腺癌的精准区域处理: 演进与展望[J]. 中国癌症杂志, 2022, 32(8): 680-687. doi: 10.19401/j.cnki.1007-3639.2022.08.002
	QIU P F, WANG Y S. Precise regional management of breast cancer in the sentinel lymph node era: evolution and prospect[J]. China Oncol, 2022, 32(8): 680-687.
[10]	QIU P F, LIU J J, LIU Y B, et al. A modified technology could significantly improve the visualization rate of the internal mammary sentinel lymph nodes in breast cancer patients[J]. Breast Cancer Res Treat, 2012, 136(1): 319-321. doi: 10.1007/s10549-012-2203-5
[11]	QIU P F, WANG Y S. ASO author reflections: internal mammary sentinel lymph node biopsy-time for the back of internal mammary staging?[J]. Ann Surg Oncol, 2020, 27(2): 384-385. doi: 10.1245/s10434-019-07838-2
[12]	VERONESI U, CASCINELLI N, BUFALINO R, et al. Risk of internal mammary lymph node metastases and its relevance on prognosis of breast cancer patients[J]. Ann Surg, 1983, 198(6): 681-684. doi: 10.1097/00000658-198312000-00002 pmid: 6639172
[13]	KIM Y B, BYUN H K, KIM D Y, et al. Effect of elective internal mammary node irradiation on disease-free survival in women with node-positive breast cancer: a randomized phase 3 clinical trial[J]. JAMA Oncol, 2022, 8(1): 96-105. doi: 10.1001/jamaoncol.2021.6036
[14]	MATZINGER O, HEIMSOTH I, POORTMANS P, et al. Toxicity at three years with and without irradiation of the internal mammary and medial supraclavicular lymph node chain in stage Ⅰ to Ⅲ breast cancer (EORTC trial 22922/10925)[J]. Acta Oncol, 2010, 49(1): 24-34. doi: 10.3109/02841860903352959
[15]	POORTMANS P M, STRUIKMANS H, DE BROUWER P, et al. Side effects 15 years after lymph node irradiation in breast cancer: randomized EORTC trial 22922/10925[J]. J Natl Cancer Inst, 2021, 113(10): 1360-1368. doi: 10.1093/jnci/djab113
[16]	THORSEN L B, THOMSEN M S, BERG M, et al. CT-planned internal mammary node radiotherapy in the DBCG-IMN study: benefit versus potentially harmful effects[J]. Acta Oncol, 2014, 53(8): 1027-1034. doi: 10.3109/0284186X.2014.925579 pmid: 24957557
[17]	CAO X S, YANG G R, CONG B B, et al. The lymphatic drainage pattern of internal mammary sentinel lymph node identified by small particle radiotracer (^99mTc-dextran 40) in breast[J]. Cancer Res Treat, 2019, 51(2): 483-492. doi: 10.4143/crt.2018.062
[18]	CONG B B, QIU P F, LIU Y B, et al. Validation study for the hypothesis of internal mammary sentinel lymph node lymphatic drainage in breast cancer[J]. Oncotarget, 2016, 7(27): 41996-42006. doi: 10.18632/oncotarget.v7i27
[19]	邱鹏飞. 新型示踪技术引导乳腺癌内乳前哨淋巴结活检术的显像率与适应证研究[D]. 济南: 山东大学, 2020.
[20]	孙晓. 乳腺癌内乳区前哨淋巴结活检术的前瞻性临床验证研究[D]. 济南: 山东大学, 2020.
[21]	WANG Y S, LV Q, ZHU S G, et al. Prospective, multicenter, clinical validation study of the repeatability and accuracy of internal mammary sentinel lymph node biopsy with modified injection technique (CBCSG026/CBCSG027)[C]. 2022 San Antonio Breast Cancer Symposium; San Antonio, TX, Dec 6-10, 2022 (abstr P2-14-06).

Item	Case (n=537)	Percentage/%	Item	Case (n=537)	Percentage/%
Age	48.9±9.0 (27.0-78.0)		Grade
BMI	23.9±3.1 (16.4-39.7)		Ⅰ	9	1.7
Menopausal status			Ⅱ	326	60.7
No	331	61.6	Ⅲ	163	30.3
Yes	206	38.4	N/A	39	7.3
Laterality			No. of ALN positive
Left	305	56.8	0	263	49.0
Right	232	43.2	1-3	173	32.2
Tumor location			4-9	57	10.6
Lateral	282	52.5	≥10	44	8.2
Central/medial	248	46.2	IMSLN
Unknown	7	1.3	Negatvie	440	81.9
Pathological size/cm			Positive	97	18.1
≤2	271	50.4	ER
2-5	243	45.3	Negatvie	133	24.8
>5	23	4.3	Positive	404	75.2
Histological type			PR
Ductal	483	89.9	Negatvie	168	31.3
Lobular	15	2.8	Positive	369	68.7
Mucinous	8	1.5	HER2
Microinfiltration	23	4.3	Negatvie	380	70.8
Other special types	8	1.5	Positive	132	24.6
Lymphatic invasion			N/A	25	4.6
No	465	86.6	Tumor subtype
Yes	72	13.4	HR positive/HER2 negatvie	316	58.8
No. of IMSLN	1.8±0.9 (1-6)		HER2 positive	132	24.6
Surgery type			TNBC	64	11.9
Mastectomy	502	93.5	N/A	25	4.7
Lumpectomy	35	6.5

Variables	DFS				OS
	Univariate Cox analysis		Multivariate Cox analysis		Univariate Cox analysis		Multivariate Cox analysis
	HR (95% CI)	P value	HR (95% CI)	P value	HR (95% CI)	P value	HR (95% CI)	P value
IMSLN (positive vs negative)	5.908 (3.194-10.928)	<0.001	3.652 (1.832-7.281)	<0.001	6.927 (2.783-17.240)	<0.001	3.232 (1.153-9.058)	0.026
Age	0.994 (0.960-1.030)	0.749			1.034 (0.984-1.086)	0.190
Menopausal status (yes vs no)	1.338 (0.721-2.480)	0.356			1.712 (0.694-4.222)	0.243
Tumor location (lateral vs central/medial)	1.622 (0.871-3.020)	0.127			1.993 (0.785-5.063)	0.147
No. of positive ALN	1.121 (1.083-1.160)	<0.001	1.090 (1.045-1.137)	<0.001	1.138 (1.082-1.196)	<0.001	1.100 (1.032-1.173)	0.003
Pathological size (cm)		0.002		0.006		<0.001		0.013
2-5 (vs≤2)	1.484 (0.760-2.899)	0.248	0.769 (0.374-1.577)	0.473	4.430 (1.250-15.700)	0.021	2.597 (0.697-9.673)	0.155
>5 (vs≤2)	5.367 (2.080-13.848)	<0.001	3.571 (1.357-9.395)	0.010	17.214 (3.850-76.970)	<0.001	9.514 (2.023-44.749)	0.004
Histological grade (Ⅲ vs Ⅰ-Ⅱ)	2.270 (1.230-4.189)	0.009	2.367 (1.273-4.400)	0.006	1.129 (0.429-2.973)	0.806
Lymphatic invasion (yes vs no)	1.106 (0.433-2.827)	0.833			1.137 (0.261-4.945)	0.864
ER (ER⁺ vs ER^-)	0.550 (0.291-1.039)	0.065			0.449 (0.180-1.115)	0.085
PR (PR⁺ vs PR^-)	0.668 (0.357-1.252)	0.208			0.575 (0.231-1.429)	0.233
HER2 (HER2⁺ vs HER2^-)	1.171 (0.583-2.353)	0.657			1.072 (0.386-2.979)	0.893
Tumor subtype		0.219				0.209
HER2+ ( vs HR⁺/HER2^-)	1.372 (0.657-2.864)	0.400			1.382 (0.463-4.124)	0.562
TN (vs HR⁺/HER2^-)	2.049 (0.902-4.653)	0.087			2.683 (0.899-8.011)	0.077
Radiotherapy (yes vs no)	1.384 0.731-2.621)	0.319			1.856 (0.686-5.024)	0.223

Item	No IMNI (n=142)	IMNI (n=101)	5-year DFS (IMNI vs no IMNI)	P value	HR (95% CI)
T₁	47	39	91.9% vs 85.5%	0.974	1.026 (0.228-4.617)
T_2-3	95	62	84.7% vs 90.3%	0.225	1.875 (0.680-5.175)
N₁	109	41	100.0% vs 92.7%	0.356	0.029 (0.000-52.000)
N_2-3	29	60	77.4% vs 74.6%	0.672	1.257 (0.435-3.633)
Ⅰ-Ⅱ	100	26	100.0% vs 95.2%	0.539	0.036 (0.000-1 486.000)
Ⅲ	42	75	82.5% vs 74.6%	0.919	0.952 (0.369-2.458)
Lateral	84	43	87.9% vs 90.1%	0.872	1.145 (0.218-6.009)
Central/medial	54	57	83.4% vs 85.8%	0.503	1.423 (0.506-3.998)
IMSLN positive	19	67	87.3% vs 52.5%	0.040	0.286 (0.087-0.943)
IMSLN negative	123	34	84.5% vs 96.5%	0.099	3.269 (0.488-21.890)

RILI	IMSLN^- (n=157)				P value	OR (95% CI)
	No IMNI (n=123)		IMNI (n=34)
	Grade 1-2	Grade 3	Grade 1-2	Grade 3
Acute pneumonitis	7 (5.7%)	0 (0.0%)	3 (8.8%)	0 (0.0%)	0.883	1.465 (0.360-5.960)
Delayed pneumonitis or fibrosis	10 (8.1%)	0 (0.0%)	10 (29.4%)	0 (0.0%)	<0.050	4.708 (1.870-11.840)
Total	17 (13.8%)		13 (38.2%)		<0.050	3.678 (1.604-8.434)
RILI	IMSLN⁺ (n=86)				P value	OR (95% CI)
	No IMNI (n=19)		IMNI (n=67)
	Grade 1-2	Grade 3	Grade 1-2	Grade 3
Acute pneumonitis	0 (0.0%)	0 (0.0%)	8 (11.9%)	0 (0.0%)	0.252	-
Delayed pneumonitis or fibrosis	2 (10.5%)	0 (0.0%)	10 (14.9%)	0 (0.0%)	0.909	1.491 (0.300-7.410)
Total	2 (10.5%)		18(26.8%)		0.234	3.122 (0.700-13.990)

乳腺癌内乳前哨淋巴结活检评估预后及指导个体化内乳照射：一项长期随访研究

Internal mammary sentinel lymph node biopsy for breast cancer: a long-term follow-up research for assessment of prognosis and guiding individualized internal mammary lymph node irradiation

RichHTML

PDF

可视化

摘要/Abstract

引用本文

使用本文

图/表 6

参考文献 21

相关文章 15

编辑推荐

Metrics

本文评价

[1]	金奕滋, 林明曦, 张剑. 乳腺癌原发灶与肝转移灶受体表达差异研究[J]. 中国癌症杂志, 2023, 33(9): 834-843.
[2]	吴晗, 杨章孺, 冯雯, 曾琬琴, 郭金栋, 李洪选, 王常禄, 王家明, 吕长兴, 张琴, 余雯, 蔡旭伟, 傅小龙. 多原发性早期肺癌立体定向放射治疗后疗效及患者预后分析[J]. 中国癌症杂志, 2023, 33(9): 844-856.
[3]	陈金娟, 王星然, 李文质, 程煜, 孙艺华, 陶祥, 马凤华, 孙莉, 赵洪波, 鹿欣. 保守手术治疗的10例Ⅰ期胎盘部位滋养细胞肿瘤病例报告及文献复习[J]. 中国癌症杂志, 2023, 33(9): 857-865.
[4]	孙洋, 王炼, 赵萌, 张小凤, 耿志军, 王月月, 宋雪, 左芦根, 李静, 胡建国. 胃癌中FKBP1A高表达的预后价值及其靶向PI3K/AKT对糖代谢的调控作用[J]. 中国癌症杂志, 2023, 33(8): 726-739.
[5]	姜琳, 刘绮颖, 贾利晴, 张静, 常恒, 薛田, 任敏, 柏乾明, 朱晓丽, 周晓燕. 胶质瘤中MGMT甲基化状态及其临床意义的回顾性研究[J]. 中国癌症杂志, 2023, 33(8): 740-750.
[6]	杨忠毅, 许晓平, 王明伟, 张勇平, 杨建伟, 陈跃, 徐文贵, 李亚明, 章英剑, 宋少莉. 乳腺癌¹⁸F-FES雌激素受体PET技术和应用标准[J]. 中国癌症杂志, 2023, 33(8): 801-808.
[7]	王若曦, 吉芃, 龚悦, 陈盛. HER2低表达乳腺癌新辅助化疗效果及其预后特征：一项单中心回顾性研究[J]. 中国癌症杂志, 2023, 33(7): 686-692.
[8]	邬思雨, 李俊杰, 邵志敏. 乳腺癌前哨淋巴结活检术的发展历史及研究进展[J]. 中国癌症杂志, 2023, 33(6): 551-559.
[9]	毕钊, 王永胜. 1~2枚前哨淋巴结阳性早期乳腺癌患者治疗策略降阶梯新理念[J]. 中国癌症杂志, 2023, 33(6): 560-565.
[10]	赵谦, 凌云霄, 柳光宇. 乳腺癌患者保乳手术后再次前哨淋巴结活检的最新研究进展及展望[J]. 中国癌症杂志, 2023, 33(6): 566-573.
[11]	丛斌斌, 曹晓珊, 王春建, 邱鹏飞, 孙晓, 陈鹏, 刘雁冰, 赵桐, 张朝蓬, 石志强, 毕钊, 王永胜. 临床查体阴性但超声检查及穿刺确诊腋窝淋巴结转移的乳腺癌前哨淋巴结活检的可行性分析[J]. 中国癌症杂志, 2023, 33(6): 574-580.
[12]	任恒宇, 郝爽, 陈嘉健, 杨犇龙, 曹阿勇, 柳光宇, 邵志敏, 吴炅. 国内外乳房重建研究的现状和重点：一项文献计量学研究[J]. 中国癌症杂志, 2023, 33(6): 581-588.
[13]	陈璐艳, 王丽雪, 傅佩芬. 新发Ⅳ期乳腺癌患者手术价值探讨[J]. 中国癌症杂志, 2023, 33(5): 431-436.
[14]	左学良, 陈志强, 董润雨, 王智雄, 蔡娟. 联合检测LDHA和PD-L1在晚期胃癌PD-1抑制剂疗效预测及预后评估中的价值[J]. 中国癌症杂志, 2023, 33(5): 460-468.
[15]	杨闻箫, 国琳玮, 凌泓, 胡欣. 基于免疫微环境特征的曲妥珠单抗与免疫治疗联合应用预测模型[J]. 中国癌症杂志, 2023, 33(5): 484-498.