A nomogram for predicting the likelihood of additional nodal metastases in breast cancer patients with a positive sentinel node biopsy
A nomogram for predicting the likelihood of additional nodal metastases in breast cancer patients with a positive sentinel node biopsy
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DOI：
10.1245/aso.2003.03.015
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发表时间：
2003-12-01
影响因子：
3.7
通讯作者：
Kattan, MW
中科院分区：
文献类型：
--
作者：
Van Zee, KJ;Manasseh, DME;Kattan, MW
背景资料：前哨淋巴结（SLN）转移的乳腺癌患者的标准治疗包括完全腋窝淋巴结清扫（ALND）。然而，许多人质疑是否需要在每一个可检测到SLN转移的患者中进行完全ALND，特别是那些认为非SLN转移风险低的患者。准确估计的可能性，额外的疾病在腋窝可以大大有助于决策关于进一步treatment.Methods：原发性肿瘤和SLN转移的702例患者进行了完整的ALND的病理特征进行了评估与多变量Logistic回归预测这些患者的非SLN中存在额外的疾病。使用病理大小、肿瘤类型和核分级、淋巴管浸润、多灶性和原发肿瘤的雌激素受体状态、前哨淋巴结转移的检测方法、阳性前哨淋巴结的数量和阴性前哨淋巴结的数量创建列线图。该模型随后被应用于前瞻性373 patients.Results：诺模图的回顾性人群是准确的和歧视，与受试者工作特征（ROC）曲线下面积为0.76。当应用于前瞻性组，该模型准确预测的可能性非SLN疾病（ROC，0.77）。结论：我们已经开发了一个用户友好的诺模图，使用的信息通常可供外科医生，以方便和。准确计算个体患者发生额外非SLN转移的可能性。
Background: The standard of care for breast cancer patients with sentinel lymph node (SLN) metastases includes complete axillary lymph node dissection (ALND). However, many question the need for complete ALND in every patient with detectable SLN metastases, particularly those perceived to have a low risk of non-SLN metastases. Accurate estimates of the likelihood of additional disease in the axilla could assist greatly in decision-making regarding further treatment.Methods: Pathological features of the primary tumor and SLN metastases of 702 patients who underwent complete ALND were assessed with multivariable logistic regression to predict the presence of additional disease in the non-SLNs of these patients. A nomogram was created using pathological size, tumor type and nuclear grade, lymphovascular invasion, multifocality, and estrogen-receptor status of the primary tumor; method of detection of SLN metastases; number of positive SLNs; and number of negative SLNs. The model was subsequently applied prospectively to 373 patients.Results: The nomogram for the retrospective population was accurate and discriminating, with an area under the receiver operating characteristic (ROC) curve of 0.76. When applied to the prospective group, the model accurately predicted likelihood of non-SLN disease (ROC, 0.77).Conclusions: We have developed a user-friendly nomogram that uses information commonly available to the surgeon to easily and. accurately calculate the likelihood of having additional, non-SLN metastases for an individual patient.