【摘要】：第一部分Gai l乳腺癌模型應(yīng)用價(jià)值研究目的:乳腺癌是女性最為常見(jiàn)的惡性腫瘤,早期發(fā)現(xiàn)與干預(yù)是降低乳腺癌危害的關(guān)鍵,歐美國(guó)家通過(guò)乳腺癌風(fēng)險(xiǎn)評(píng)估與大規(guī)模篩查等措施取得顯著的成效。Gail乳腺癌風(fēng)險(xiǎn)評(píng)估模型是歐美國(guó)家最為常用的乳腺癌風(fēng)險(xiǎn)評(píng)估工具,本研究旨在探討Gail乳腺癌風(fēng)險(xiǎn)評(píng)估模型在中國(guó)人群的適用性,評(píng)估其應(yīng)用價(jià)值。資料與方法:系統(tǒng)性研究2015年1月至2016年12月間就診于山東大學(xué)齊魯醫(yī)院經(jīng)病理證實(shí)為乳腺癌患者150名;對(duì)照組按照年齡1:1匹配150人,對(duì)照組女性均行乳腺彩超或乳腺X線檢查并至少經(jīng)2名副主任職稱以上乳腺外科醫(yī)生診斷為健康女性(無(wú)乳腺疾病)。收集乳腺癌組與對(duì)照組女性年齡、月經(jīng)初潮年齡、第一次生育年齡、既往乳腺活檢史及是否伴有不典型增生、一級(jí)親屬乳腺癌發(fā)病人數(shù)、種族等信息,采用美國(guó)國(guó)家癌癥研究中心(National Cancer Institute)官網(wǎng)發(fā)布的基于Gail乳腺癌風(fēng)險(xiǎn)評(píng)估模型的乳腺癌風(fēng)險(xiǎn)評(píng)估工具(Breast Cancer Risk Assessment Tool)分析研究對(duì)象5年前乳腺癌發(fā)病風(fēng)險(xiǎn),對(duì)照患者實(shí)際發(fā)病情況研究Gail乳腺癌風(fēng)險(xiǎn)評(píng)估模型的應(yīng)用價(jià)值。結(jié)果:Gail乳腺癌風(fēng)險(xiǎn)評(píng)估模型評(píng)估中國(guó)女性乳腺癌發(fā)病風(fēng)險(xiǎn)靈敏度為11.33%,特異度為93.33%,約登指數(shù)為0.047,ROC曲線下面積為0.533。結(jié)論 Gail乳腺癌風(fēng)險(xiǎn)評(píng)估模型對(duì)中國(guó)女性乳腺風(fēng)險(xiǎn)評(píng)估效果不理想。第二部分乳腺導(dǎo)管內(nèi)乳頭狀腫瘤良惡性危險(xiǎn)因素研究背景與目的:乳腺導(dǎo)管內(nèi)乳頭狀腫瘤(Breast Intraductal Papillary Neoplasm,IDPN)是臨床常見(jiàn)的一類乳腺疾病,指乳腺導(dǎo)管內(nèi)增生的上皮被覆于纖維血管軸心的表面后形成樹枝狀結(jié)構(gòu)改變的乳腺組織病變,伴有或不伴有肌上皮細(xì)胞層,包括良性、交界性、惡性三種病變。2012版《世界衛(wèi)生組織乳腺腫瘤分類》中將乳腺導(dǎo)管內(nèi)乳頭狀病變分為導(dǎo)管內(nèi)乳頭狀瘤(包括中央型與外周型)、導(dǎo)管內(nèi)乳頭狀瘤伴不典型導(dǎo)管增生和導(dǎo)管原位癌、導(dǎo)管內(nèi)乳頭狀癌(包含導(dǎo)管內(nèi)、包裹性、實(shí)性乳頭狀癌)。由于導(dǎo)管內(nèi)乳頭狀腫瘤包含一組異質(zhì)性腫瘤,臨床表現(xiàn)、輔助檢查、組織學(xué)特征存在重疊,給臨床診治帶來(lái)巨大困難。本研究旨在分析歸納乳腺導(dǎo)管內(nèi)乳頭狀腫瘤良惡性發(fā)病危險(xiǎn)因素,建立導(dǎo)管內(nèi)乳頭狀腫瘤良惡性風(fēng)險(xiǎn)模型,評(píng)估其應(yīng)用價(jià)值。資料和方法:回顧性分析2008年01月至2015年12月間于山東大學(xué)齊魯醫(yī)院就診行手術(shù)治療經(jīng)病理證實(shí)為乳腺導(dǎo)管內(nèi)乳頭狀癌(包括導(dǎo)管內(nèi)乳頭狀癌、實(shí)行乳頭狀癌、包裹性乳頭狀癌)病人90例,通過(guò)1:2年齡匹配(年齡±3歲)匹配手術(shù)病理證實(shí)為乳腺導(dǎo)管內(nèi)乳頭狀瘤病人180例,詳細(xì)研究對(duì)象信息。首先比較病例組與對(duì)照組之間的差異,采用單因素分析篩出選乳腺導(dǎo)管內(nèi)乳頭狀腫瘤良惡性腫瘤的危險(xiǎn)因素,針對(duì)單因素分析之中具有統(tǒng)計(jì)學(xué)意義的變量行多因素logistic回歸分析,基于回歸參數(shù)及臨床意義行必要調(diào)整合理賦值,建立乳腺導(dǎo)管內(nèi)乳頭狀腫瘤良惡性鑒別模型,使用ROC曲線選擇合適的結(jié)點(diǎn),探討此方法的準(zhǔn)確性與可行性。結(jié)果:單因素分析中共篩選出4個(gè)具有統(tǒng)計(jì)學(xué)差異的危險(xiǎn)因素,分別是體重指數(shù)BMI(P0.05),既往導(dǎo)管內(nèi)乳頭狀瘤病史(P0.05),月經(jīng)狀態(tài)(P0.05)乳腺癌家族史(P0.05),經(jīng)過(guò)Logistic回歸分析,最終得到的模型為:1n(P/1-P)=-1.140+0.514*X1+1.031*X2+0.444*X3+01.261*X4;經(jīng) ROC 曲線對(duì)Logistic模型進(jìn)行評(píng)價(jià),曲線下面積為0.653,95%置信區(qū)間為0.577-0.728。
[Abstract]:The first part is the application value of Gai l breast cancer model. Objective: Breast cancer is the most common malignant tumor in women. Early detection and intervention is the key to reduce the risk of breast cancer. Materials and Methods: A systematic study was conducted on 150 patients with breast cancer confirmed by pathology in Qilu Hospital of Shandong University from January 2015 to December 2016. The control group was divided into two groups according to the age of 1:1 pi. The age of women in breast cancer group and control group, menarche age, first birth age, previous breast biopsy history and atypical hyperplasia were collected. Breast Cancer Risk Assessment Tool (Breast Cancer Risk Assessment Tool), published on the official website of the National Cancer Institute, was used to analyze the risk of breast cancer five years ago. Results: The sensitivity, specificity, Jordan index and area under ROC curve of Gail breast cancer risk assessment model were 11.33%, 93.33%, 0.047 and 0.533 respectively. Conclusion Gail breast cancer risk assessment model has no significant effect on Chinese women breast cancer risk assessment. Objective: Breast intraductal Papillary Neoplasm (IDPN) is a common clinical breast disease. It refers to the dendritic structural alteration of the hyperplastic epithelium of the breast duct on the surface of the fibrovascular axis. Metaplastic breast tissue lesions with or without myoepithelial cell layers, including benign, borderline, and malignant lesions. The 2012 edition of the WHO Breast Tumor Classification classifies intraductal papillomas into intraductal papillomas (including central and peripheral types), intraductal papillomas with atypical ductal hyperplasia and ductogenesis. Intraductal papillary carcinoma (including intraductal, encapsulated, solid papillary carcinoma). Because intraductal papillary tumors contain a group of heterogeneous tumors, the overlap of clinical manifestations, auxiliary examinations, and histological features makes clinical diagnosis and treatment difficult. This study aims to analyze and summarize the risk of benign and malignant breast intraductal papillary tumors. Materials and Methods: From January 2008 to December 2015, we retrospectively analyzed the surgical treatment of intraductal papillary carcinoma (including intraductal papillary carcinoma, papillary carcinoma, encapsulated papillary carcinoma) in Qilu Hospital of Shandong University. Ninety patients with breast intraductal papilloma were confirmed by matching operation and pathology at 1:2 years old (age (+ 3 years old). Detailed information on the subjects was provided. First, the differences between the case group and the control group were compared, and the risk factors of benign and malignant breast intraductal papilloma were screened out by single factor analysis. Multivariate logistic regression analysis was used to identify the benign and malignant breast intraductal papillary neoplasms. The ROC curves were used to select the appropriate nodes to explore the accuracy and feasibility of the method. Four risk factors with statistical differences were screened out, including body mass index BMI (P 0.05), previous intraductal papillomatosis (P 0.05), menstrual status (P 0.05) family history of breast cancer (P 0.05). Logistic regression analysis showed that the final model was: 1n (P/1-P) = - 1.140 + 0.514 * X1 + 1.031 * X2 + 0.444 * X3 + 01.261 * X4; and Logis (P/1-P) = - 1.140 + 0.514 * X1 + 1.031 * X2 + 0.444 * X3 + The tic model was evaluated, the area under the curve was 0.653,95%, and the confidence interval was 0.577-0.728.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.9

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