Re-excision or "wait and watch"-a prediction model in breast phyllodes tumors after surgery
Re-excision or "wait and watch"-a prediction model in breast phyllodes tumors after surgery
复制标题
乳腺叶状肿瘤术后再次切除或“等待观察”的预测模型
DOI：
10.21037/atm.2020.02.26
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发表时间：
2020-03-01
影响因子：
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通讯作者：
Yao, Herui
中科院分区：
文献类型：
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作者：
Chao, Xue;Jin, Xiaoyan;Yao, Herui
背景乳腺叶状肿瘤的预后主要依赖于病理分级，缺乏客观性。本研究旨在根据临床病理特征建立列线图，以评估术后PT的复发概率。方法收集2005年1月至2014年12月在中山纪念医院接受手术治疗的334例乳腺PT患者的资料，建立预测模型。此外，还利用同期北京大学深圳医院36例患者（队列1）和中山大学肿瘤防治中心140例患者（队列2）的数据对模型进行了验证。对病历和肿瘤切片进行回顾性分析。使用对数秩和考克斯回归检验建立乳腺PT的临床预测模型。所有统计分析均使用R和STATA进行。结果334例患者中，良性肿瘤224例，交界性肿瘤91例，恶性肿瘤19例。1、3、5年无复发生存率分别为98.5%、97.9%、96.8%。与开放手术相比，超声引导真空辅助活检（UGVAB）是良性PT的非劣效性治疗应用[风险比（HR），2.38; 95%置信区间（CI），0.59-9.58]。手术切缘宽度、核分裂和肿瘤边界被确定为乳腺PT的独立风险因素。根据这三个变量，绘制了列线图。内部和外部验证的C指数分别为0.71、0.67（队列1）和0.73（队列2）。结论该研究模型提供了更简洁、客观的变量来评估患者术后无复发生存率，有助于决定是否再次切除或“等待观察”。
Background The prognosis of breast phyllodes tumors (PTs) largely depending on the pathological grading, which lacks objectivity. This study aimed to develop a nomogram based on clinicopathological features to evaluate the recurrence probability of PTs following surgery. Methods Data from 334 patients with breast PTs, who underwent surgical treatment at Sun Yat-sen Memorial Hospital from January 2005 to December 2014, were used to develop a prediction model. Additionally, data of 36 patients from Peking University Shenzhen Hospital (cohort 1) and data of 140 patients from Sun Yat-sen University Cancer Center (cohort 2) during the same period were used to validate the model. The medical records and tumor slides were retrospectively reviewed. The log-rank and Cox regression tests were used to develop a clinical prediction model of breast PTs. All statistical analyses were performed using R and STATA. Results Of all 334 patients included in the primary cohort, 224 had benign, 91 had borderline, and 19 had malignant tumors. The 1-, 3-, and 5-year recurrence-free survival was 98.5%, 97.9%, and 96.8%, respectively. Ultrasound-guided vacuum-assisted biopsy (UGVAB) is a non-inferior treatment application in benign PTs compared with open surgery [hazard ratio (HR), 2.38; 95% confidence interval (CI), 0.59–9.58]. Width of surgical margin, mitoses, and tumor border were identified as independent risk factors for breast PTs. A nomogram was developed based on these three variables. The C-index of internal and external validation was 0.71, 0.67 (cohort 1) and 0.73 (cohort 2), respectively. Conclusions The study model presented more concise and objective variables to evaluate the recurrence-free survival of patients after surgery, which can help deciding whether to do a re-excision or “wait and watch”.