吉林大学学报(医学版)

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乳腺癌新辅助化疗后原发肿瘤退缩模式预测列线图的建立

刘雁冰1,杨 涛2,张朝蓬1,王春建1,孙 晓1,孙翔宇3,穆殿斌3,陈兆秋4,王永胜1   

  1. 1.山东省肿瘤医院乳腺病中心,山东 济南 250117;2.江苏省连云港市第一人民医院放疗科,江苏 连云港 
    222000;3.山东省肿瘤医院病理科,山东 济南 250117;4.山东省肿瘤医院放射科,山东 济南 250117
  • 收稿日期:2014-04-18 出版日期:2014-11-28 发布日期:2015-01-18
  • 通讯作者: 王永胜(Tel:0531-67626211,E-mail:wangysh2008@aliyun.com) E-mail:wangysh2008@aliyun.com
  • 作者简介:刘雁冰(1975-),女,山东省济南市人,主治医师,医学硕士,主要从事乳腺癌保乳方面的研究。
  • 基金资助:

    山东省科技厅科技发展计划项目资助课题(2013YD18030);山东省卫生厅医药卫生科技发展计划项目资助课题(2011HD012)

Establishment of nomograms to predict shrinkage modes of  primary  breast tumor after neoadjuvant chemotherapy

LIU Yan-bing1,YANG Tao2, ZHANG Zhao-peng1,WANG Chun-jian1,SUN Xiao1,SUN Xiang-yu3,MU Dian-bin3,CHEN Zhao-qiu4,WANG Yong-sheng1   

  1. 1. Breast Cancer Center,Shandong Cancer Hospital,Ji’nan 250117,China;2. Department of Radiotherapy,First People’s Hospital of Lianyungang City,Lianyungang 222000,China;3. Department of Pathology,Shandong Cancer Hospital,Ji’nan 250117,China;4. Department of Radiology,Shandong Cancer Hospital,Ji’nan 250117,China
  • Received:2014-04-18 Online:2014-11-28 Published:2015-01-18

摘要:

目的:探讨乳腺癌新辅助化疗(NAC)后原发肿瘤退缩模式的影响因素,构建非向心性退缩的预测列线图。方法:选择61例ⅡA-ⅢC期乳腺浸润性导管癌患者作为研究对象,NAC后手术标本制作次连续病理大切片,显微镜下勾画残余肿瘤范围,Photoshop CS 5软件配准,3D-DOCTOR 4.0软件三维重建病理及MRI残余肿瘤,评价NAC后原发肿瘤的病理、临床-病理退缩模式。以年龄、体质量指数(BMI)和月经状况等17个因素为自变量,临床-病理退缩模式为因变量,应用Logistic逐步回归模型建立列线图。结果: NAC前原发肿瘤分期、NAC后淋巴结降期、孕激素受体(PR)和NAC前钼靶恶性钙化是预测非向心性退缩的独立影响因素(P<0.05),回归系数分别为1.538、1.555、-1.707和-1.405,OR(OR95%CI)分别为4.656(1.414~15.328)、4.735(1.082~20.722)、0.181(0.044~0.741)和0.245(0.061~0
.998)。用于预测非向心性退缩风险的列线图的一致系数为0.869,符合度平均绝对差为0.039。结论:基于乳腺癌原发灶的临床、病理特征,构建预测NAC后乳腺癌原发肿瘤退缩模式的列线图,有助于个体化地选择NAC后行保乳治疗的患者。

关键词:  , 乳腺肿瘤;新辅助化疗;三维重建;退缩模式;列线图

Abstract:

Objective To explore the clinical variables associated with the shrinkage modes of primary breast tumor in women after neoadjuvant chemotherapy (NAC),and to develop a nomogram for predicting non-concentric shrinkage mode(NCSM).Methods Sixty-one women with pathologically proven solitary invasive ductal carcinoma(ⅡA-ⅢC) were recruited.Breast specimen was prepared with PMSS,and residual tumors were microscopically outlined,scanned and registered by Photoshop CS 5 software.The 3D model of residual tumors was reconstructed with 3D-DOCTOR 4.0 software to evaluate the shrinkage mode.17 factors such as age and body mass index and menopausal status were chosen as independent variables,and the clinic-pathologic shrinkage mode was considered as dependent variable.A Logistic regression model was used to construct the nomogram.Results Primary tumor stage,lymph node down-staging,PR and mammographic malignant calcification before NAC were independent predictors of clinic-pathologic shrinkage mode (β:1.538,OR:4.656,95%CI:1.414-15.328,P=0.011;β:1.555,OR:4.735,95%CI:1.082-20.722,P=0.039;β:-1.707,OR:0.181,95%CI:0.044-0.741,P=0.017;β:-1.405,OR:3.808,95%CI:0.06-0.998,P=0.048,respectively ).The nomogram predicting the risk of NCSM showed a good concordance index(0.869),and its conformity of mean absolute error was 0.039.Conclusion Based on the clinicopathological findings of primary breast tumor,a nomogram to predict shrinkage modes after NAC in breast carcinoma  patients is constructed.The statistical tool is helpful for individually selecting the patients who can be treated with BCT after NAC.

Key words:  , breast neoplasms, neoadjuvant chemotherapy, three-dimensional reconstruction, shrinkage modes, nomogram

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