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目的探索乳腺癌非前哨淋巴结(NSLN)转移的危险因素,验证纪念斯隆凯特琳癌症中心(MSKCC)列线图的临床应用价值。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的1227例乳腺癌病人,评估前哨淋巴结(SLN)阳性病人NSLN转移的危险因素。登陆MSKCC网站计算病人NSLN转移风险,通过绘制趋势线和计算受试者工作特征曲线(ROC)下面积(AUC)评估预测准确性。结果肿瘤大小、SLN阳性数、组织学分级、脉管侵犯和多灶性与NSLN转移差异有统计学意义(P<0.05),其中肿瘤大小、SLN阳性数、组织学分级和脉管侵犯是NSLN转移的独立预测因素。趋势线显示预测值曲线和真实值曲线趋势基本相同,MSKCC列线图的AUC值为0.765,预测值<10%的病人(51/412,12.4%)NSLN阳性率为5.9%(3/51)。结论 MSKCC列线图可以较准确的预测NSLN转移风险,为病人是否行腋窝淋巴结清扫术(ALND)提供参考依据,预测值<10%的病人可以避免ALND。
Objective To explore the risk factors of non-sentinel lymph node (NSLN) metastasis in breast cancer and verify the clinical value of Memorial Sloan Kettering Cancer Center (MSKCC). Methods 1227 breast cancer patients who underwent SLN biopsy from December 2001 to January 2012 in Shandong Tumor Hospital were retrospectively analyzed to evaluate the risk factors of NSLN metastasis in SLN-positive patients. The MSKCC website was used to calculate the patient NSLN metastasis risk and the prediction accuracy was assessed by plotting the trend line and calculating the area under the receiver operating characteristic curve (ROC). Results The tumor size, SLN positive number, histological grade, vascular invasion and multifocality were significantly different from those of NSLN metastasis (P <0.05). The tumor size, SLN positive number, histological grade and vascular invasion were NSLN Independent predictors of metastasis. The trend line showed that the trend of predicted value curve and real value curve were basically the same. The AUC value of MSKCC collinear chart was 0.765, and the positive rate of NSLN was 5.9% (3/51) in the patients with predicted value <10% (51 / 412,12.4%). . Conclusion The MSKCC nomogram can predict the NSLN metastasis risk more accurately and provide a reference for patients with axillary lymph node dissection (ALND). Patients with predictive value <10% can avoid ALND.