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

摘要

Objective To explore the clinical variables associated with the shrinkage modes of primary breast tumor in women after neoadj uvant 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.%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。