本文選題：乳腺癌 + 前哨淋巴結(jié)轉(zhuǎn)移�。� 參考：《濟南大學(xué)》2015年碩士論文

【摘要】：目的:本研究通過回顧性分析前哨淋巴結(jié)(Sentinel Lymph Node,SLN)陽性患者的臨床病理資料,探索非前哨淋巴結(jié)(NSLN)轉(zhuǎn)移的危險因素,評估MSKCC模型在中國乳腺癌患者中的臨床應(yīng)用價值;再通過分析腫瘤負(fù)荷與NSLN轉(zhuǎn)移之間的關(guān)系,進而評估Z0011試驗標(biāo)準(zhǔn)對我國患者人群的可行性。方法:收集山東省腫瘤醫(yī)院2001年12月至2015年1月接受前哨淋巴結(jié)活檢的2431例乳腺癌患者,分析SLN陽性患者NSLN轉(zhuǎn)移的危險因素。利用MSKCC模型計算每例患者NSLN轉(zhuǎn)移風(fēng)險,并通過受試者工作特征曲線(Receiver Operating Characteristic Curve,ROC)下面積(Area Under the Curve,AUC)評估該模型在中國乳腺癌患者中的臨床應(yīng)用價值。進一步篩選出除手術(shù)方式外均符合Z0011標(biāo)準(zhǔn)的患者,分析腫瘤負(fù)荷對NSLN陽性率的影響,并結(jié)合Z0011試驗ALND組的相關(guān)數(shù)據(jù),分析出與之相匹配的NSLN轉(zhuǎn)移率所對應(yīng)的腫瘤大小,進而得出更適宜中國人群的“Z0011試驗標(biāo)準(zhǔn)”。結(jié)果:第一部分研究腫瘤大小、組織學(xué)分級、脈管浸潤、多灶性、SLN陽性數(shù)和陰性數(shù)與NSLN轉(zhuǎn)移差異有統(tǒng)計學(xué)意義(P0.05),其中腫瘤大小、組織學(xué)分級、脈管浸潤、SLN陽性數(shù)和陰性數(shù)是NSLN轉(zhuǎn)移的獨立危險因素。趨勢線顯示預(yù)測值曲線和真實值曲線趨勢基本相同,MSKCC列線圖的AUC值為0.752。第二部分研究與Z0011試驗ALND組的T1比例(49%vs 68%)存在統(tǒng)計學(xué)差異(P=0.006),腫瘤負(fù)荷偏高。NSLN(+)組與NSLN(-)組間腫瘤負(fù)荷(腫瘤大小及SLN陽性數(shù))存在差異,且NSLN的陽性率及NSLN陽性數(shù)≥3枚的比例與腫瘤大小成正相關(guān)。腫瘤大小為T1的情況下NSLN陽性率為26.9%(83/308),與Z0011試驗ALND組的NSLN陽性率最為相近。本研究中保乳患者與Z0011試驗ALND進行對比分析可知:≤50歲患者的比例(72.0%vs 32.7%,P0.001)、激素受體陽性比例(28.9%vs 16.5%,P=0.002)存在統(tǒng)計學(xué)差異,T1所占比例(60.2%vs 67.9%,p=0.115)、病理類型(P=0.109)差異不存在統(tǒng)計學(xué)意義。結(jié)論:MSKCC列線圖可以較準(zhǔn)確的預(yù)測NSLN轉(zhuǎn)移風(fēng)險,為病人是否行腋窩淋巴結(jié)清掃術(shù)(ALND)提供參考依據(jù)。腫瘤大小及SLN陽性數(shù)對NSLN陽性率及轉(zhuǎn)移程度存在影響。隨著腫瘤大小的增加,NSLN陽性率及NSLN陽性數(shù)≥3枚的比例不斷增高。通過結(jié)合Z0011試驗ALND組的NSLN陽性率以及多種因素綜合分析后建議:T1患者更適合作為Z0011試驗中國適宜人群。
[Abstract]:Objective: to investigate the risk factors of nonsentinel lymph node metastasis by retrospectively analyzing the clinicopathological data of patients with Sentinel Lymph Nodetran (SLN) positive sentinel lymph nodes, and to evaluate the clinical value of MSKCC model in breast cancer in China. By analyzing the relationship between tumor load and NSLN metastasis, the feasibility of Z0011 test for Chinese patients was evaluated. Methods: 2431 breast cancer patients who received sentinel lymph node biopsy from December 2001 to January 2015 in Shandong Cancer Hospital were collected and the risk factors of NSLN metastasis in SLN positive patients were analyzed. The MSKCC model was used to calculate the risk of NSLN metastasis in each patient, and the clinical value of the model in Chinese breast cancer patients was evaluated by using the area Under the curve under the receiver Operating Characteristic curve. The patients who met the Z0011 standard except for the operation mode were screened out, and the effect of tumor load on NSLN positive rate was analyzed. The corresponding tumor size of NSLN metastasis rate was analyzed by combining the relevant data of ALND group with Z0011 test. Thus, the "Z0011 test standard" is more suitable for Chinese population. Results: in the first part, there were significant differences in tumor size, histological grade, vascular infiltration, positive and negative number of multiple foci and NSLN metastasis (P 0.05), including tumor size and histological grade. The number of positive and negative vascular infiltrations was an independent risk factor for NSLN metastasis. The trend line shows that the predicted value curve and the true value curve trend are basically the same. The AUC value of the MSKCC line diagram is 0.752. In the second part of the study, there was a statistical difference in T1 ratio of 49% vs 68 between the ALND group and the Z0011 trial group. There were significant differences in tumor load (tumor size and SLN positive number) between the high tumor load group and the NSLN- group. The positive rate of NSLN and the proportion of NSLN positive number 鈮，

本文編號：1902619