乳腺癌新辅助化疗后腋窝淋巴结转移综合预测模型的建立

目的:建立乳腺癌新辅助化疗后淋巴结转移的综合预测模型，评估新辅助化疗后淋巴结转移情况，指导临床手术方案选择。方法:回顾分析2015年1月至2018年12月143例乳腺癌新辅助化疗患者的临床、病理及影像资料，并根据术后淋巴结病理分为转移组与无转移组。采用χ2/t检验对两组指标进行单因素分析；将P<0.05的指标纳入多因素Logistic回归分析。用多因素分析有统计学意义(P<0.05)的指标构建乳腺癌新辅助化疗后淋巴结转移综合预测模型的列线图，并应用受试者工作特征（receiver operation characteristic,ROC)曲线评价此模型的性能。结果:单因素分析表明化疗方案、化疗前淋巴结穿刺病理、术前查体、术前彩超、术前CT/MRI、RECIST分级对腋窝淋巴结转移有预测作用；多因素分析表明，化疗前淋巴结穿刺病理、术前彩超、RECIST分级是新辅助化疗后腋窝淋巴结转移的独立预测因素。乳腺癌新辅助化疗后淋巴结转移的预测模型的曲线下面积为0.785，特异度为85.4%，敏感度为59.8%。结论:乳腺癌新辅助化疗后淋巴结转移的综合预测模型对腋窝淋巴结有较好的预测能力，可为选择合适的手术方式提供临床指导。

Establishment of a comprehensive prediction model for axillary lymph node metastasis after neoadjuvant chemotherapy

Objective:To establish a comprehensive prediction model of lymph node metastasis after neoadjuvant chemotherapy for breast cancer,evaluate the situation of lymph node metastasis after neoadjuvant chemotherapy,and guide the selection of clinical operation plan.Methods:The clinical and imaging data of 143 patients with neoadjuvant chemotherapy for breast cancer from January 2015 to December 2018 were retrospectively analyzed,and the patients were divided into metastatic group and non-metastatic group according to postoperative lymph node pathology.Univariate analysis was performed by chi-square test and t-test.Indicators with P<0.05 were included in multivariate Logistic regression analysis.The nomogram of the comprehensive prediction model of lymph node metastasis after neoadjuvant chemotherapy for breast cancer was constructed by multi-factor analysis with statistically significant indexes(P<0.05),and the ROC curve was applied to evaluate the performance of the model.Results:Univariate analysis showed that chemotherapy regimen,lymph node biopsy before chemotherapy,preoperative physical examination,preoperative color doppler ultrasound,preoperative CT/MRI,and RECIST grading have predictive effects on axillary lymph node metastasis.Multivariate analysis showed that pathology,preoperative color doppler ultrasound and RECIST grading are independent predictors of axillary lymph node metastasis after neoadjuvant chemotherapy.The area under the curve,specificity and sensitivity of the predictive model of lymph node metastasis after neoadjuvant chemotherapy for breast cancer were 0.785,85.4%and 59.8%respectively.Conclusion:The comprehensive prediction model of lymph node metastasis after neoadjuvant chemotherapy for breast cancer has a good prediction ability for axillary lymph node metastasis and can provide clinical guidance for the selection of appropriate surgical methods.