乳腺癌前哨淋巴结转移相关因素与MSKCC列线图的验证性研究

目的探索乳腺癌前哨淋巴结（SLN）转移的危险因素，验证纪念斯隆凯特琳癌症中心（MSKCC）模型的临床应用价值。方法回顾性分析山东省肿瘤医院2001年12月至2012年1月接受前哨淋巴结活检（SLNB）的1227例乳腺癌，其中412例SLN阳性，通过绘制趋势线和计算ROC曲线下面积（AUC）评估预测准确性，同时分析SLN转移的危险因素。结果肿瘤大小、位置、组织学分级、脉管侵犯、多灶性、ER和PR与SLN转移明显相关（P〈0．05），除肿瘤位置外均是SLN转移的独立预测因素（P〈0．01）。MSKCC模型的AUC值为0．730，预测值≤16％的患者（8．7％，107／1227）SLN阳性率为0．9％，预测值≥70％的患者（4．3％，53／1227）SLN阳性率为96．2％。结论本研究分析的SLN转移独立预测因素与MSKCC基本一致。MSKCC模型是一种有效的预测SLN转移的工具，预测值≤16％的患者可避免腋窝手术，≥70％的可直接行ALND，其他患者仍应接受SLNB。

Risk factors for sentinel lymph node metastasis and validation study of the MSKCC nomogram in breastcancer patients

Objective To evaluate the risk factors for sentinel lymph node （SLN）metastasis, and assess the value of the Memorial Sloan Kettering Cancer Center （ MSKCC ） nomogram in predicting SLN metastasis in breast cancer patients. Methods A sentinel lymph node biopsy （SLNB）database containing 1227 consecutive breast cancer patients （412 patients with a positive SLN ）was retrospectively analyzed. The value of MSKCC nomo- gram was predicted by drawing the trend line and calculating the area under the curve（AUC） of receiver-operator characteristic（ROC）. Meanwhile, the risk factors of SLN metastasis were evaluated. Results Tumor size, tumor location, histological grade, lymphovascular invasion, mulifocality, ER and PR status were correlated with SLN metastasis（ all P 〈 0.05 ）. All the above factors but tumor location were significant independent predictors for SLN metastasis（ all P 〈 0. 01 ）. The MSKCC nomogram presented AUC value of O. 730 for ROC. Patients with predictive values lower than 16% bad the frequency of 0. 9% for SLN metastasis while patients with predictive values higher than 70% had the frequency of 96. 2%. Conclusions The risk factors of SLN metastasis in our study are consistent with those in MSKCC nomogram. MSKCC nomogram is a useful tool in predicting the proba- bility of SLN metastasis for breast cancer patients. Axillary surgery can be avoided in patients with the predictive values lower than 16%, axillary lymph node dissection could be done in patients with the predictive values higher than 70%, and other patients should still undergo SLNB.