Prognostic Significance of a Novel Score Model Based on Preoperative Indicators in Patients with Breast Cancer Spine Metastases (BCSM).
Prognostic Significance of a Novel Score Model Based on Preoperative Indicators in Patients with Breast Cancer Spine Metastases (BCSM).
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基于术前指标的新型评分模型对乳腺癌脊柱转移瘤 (BCSM) 患者的预后意义。
DOI：
10.2147/cmar.s273785
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发表时间：
2020
影响因子：
3.3
通讯作者：
Xiao J
中科院分区：
文献类型：
--
作者：
Zhao C;Wang Y;Cai X;Xu W;Wang D;Wang T;Jia Q;Gong H;Sun H;Wu Z;Xiao J
手术仍然是治疗乳腺癌脊柱转移（BCSM）的主要手段，以缓解症状，提高BCSM患者的生活质量。因此，有效地预测患者的预后以决定其是否可以接受外科手术是非常重要的。然而，流行的预后评估方法缺乏特异性和敏感性的恶性肿瘤，如乳腺癌，因为它们是建立在一个相对较少的异质性类型的原发性肿瘤。本研究的目的是探索一种新的预测模型的基础上获得的临床，病理和血液参数BCSM患者接受手术干预之前。共有144例患者纳入本研究。进行单因素和多因素分析，以探讨术前参数的意义，并确定BCSM预后预测的独立因素。然后建立并验证了生存预测的诺模图。绘制时间依赖性ROC（TDROC）曲线，以评价新模型与其他评分系统（包括Tomita评分、修订的Tokuhashi评分、改良的Bauer评分和新英格兰脊柱转移评分）的准确性。P值<0.05为有统计学意义。独立因素，包括术前绝经后（P=0.034），内脏器官（P=0.021），术前Frankel评分（P=0.001），雌激素受体状态（P=0.014），血小板/淋巴细胞比值（P=0.012），淋巴细胞-单核细胞比值白蛋白-球蛋白比值（P= 0.017）进入诺模图模型，C指数为0.834（95% CI为0.789-0.890）。TDROC曲线显示，长征医院（CZ）评分系统具有最好的性能，并显示出最大的IAUC值与其他评分系统相比。我们建立了一个诺模图模型，称为CZ评分的基础上的重要因素来预测BCSM患者的预后。结果表明，CZ评分对预后评估和手术决策有较好的价值。
Surgery remains the mainstay of treatment for breast cancer spinal metastasis (BCSM) to relieve symptoms and improve the quality of life of BCSM patients. Therefore, it is important to effectively predict the prognosis of patients to determine whether they can undergo surgical operation. However, the prevalent methods for prognosis evaluation lack specificity and sensitivity for indicated malignancies like breast cancer because they are built on a relatively small number of heterogeneous types of primary tumors. The aim of the present study was to explore a novel predictive model based on the clinical, pathological and blood parameters obtained from BCSM patients before they received surgical intervention. Altogether, 144 patients were included in this study. Univariate and multivariate analyses were performed to investigate the significance of preoperative parameters and identify independent factors for prognostic prediction of BCSM. A nomogram for survival prediction was then established and validated. Time-dependent ROC (TDROC) curves were graphed to evaluate the accuracy of the novel model vs other scoring systems including Tomita Score, revised Tokuhashi Score, modified Bauer Score and New England Spinal Metastasis Score. P values <0.05 were considered statistically significant. Independent factors, including preoperative postmenopausal (P=0.034), visceral metastasIs (P=0.021), preoperative Frankel Score (P=0.001), estrogen receptor status (P=0.014), platelet-to-lymphocyte ratio (P=0.012), lymphocyte-monocyte ratio (P<0.001) and albumin-globulin ratio (P=0.017), were selected into the nomogram model with the C-index of 0.834 (95% CI, 0.789–0.890). TDROC curves showed that the Changzheng Hospital (CZ) Score system had the best performance and exhibited the largest IAUC value in comparison with the other scoring systems. We constructed a nomogram model known as CZ Score based on the significant factors to predict the prognosis for BCSM patients. The result showed that CZ Score had a better value for prognostic evaluation and surgical decision-making as compared with the other scoring systems.