摘要
目的三阴性乳腺癌(TNBC)属于异质性疾病,TNM分期难以准确预测其预后。通过对雄激素受体(AR)在TNBC中的表达分析,构建了一种新的预后模型。方法回顾性纳入176例TNBC患者的肿瘤标本,免疫组化检测AR染色强度和AR阳性细胞占比,以两者评分的乘积(简称:AR乘积)作为AR结果。对患者进行随访,分析AR与预后的关系,根据COX回归分析结果构建预后指数(PI):PI=风险系数1X变量1+风险系数2×变量2+……+风险系数n×变量n,绘制生存风险的列线图。结果AR乘积:0分103例、1分15例、2分17例、3分1例、4分9例、6分10例、9分21例。AR乘积与年龄、病理学类型、组织学分级、Ki-67、TNM有关。TNM和AR乘积是无病生存率(DFS)的独立影响因素。PI=-0.535XAR乘积+BTNM。计算每个患者的PI并分组:低风险组(PI<-3,45例)、中风险组(-3≤PI<0、114例)、高风险组(PI≥0、17例)。三组间DFS、总生存率(OS)差异均有统计学意义。绘制列线图预测3年、5年DFS,其C指数为0.719,校正曲线捉示预测值和实际结果间基本重合,提示该列线图有较好的预测能力。结论AR阳性表达预示TNBC患者更好的预后。利用AR和TNM可以构建TNBC患者的预后模型,能更:准确地预测其预后。
Objective Triple-negative breast cancer(TNBC)is a heterogeneous disease,and TNM staging system is difficult to accurately predict its prognosis.In this paper,the androgen receptor(AR)and TNM were used to construct a new prognosis model.Methods The TNBC tumor samples of 176 patients were retrospective analyses.The AR staining intensity and the proportion of AR-positive cells were detected by immunohistochemistry.The product of the two scores was taken as the AR result(AR product).The relationship between AR and prognosis was analyzed after follow-up.A prognostic index(PI)was constructed according to the results of COX regression analysis;PI=risk coefficient 1×variable 1+risk coefficient 2×variable 2+…+risk coefficient n×variable n,then a nomogram was drawn to predict the prognosis.Results The results of the AR product were 0 points in 103 cases,1 in 15 cases,2 in 17 cases,3 in 1 case,4 in 9 cases,6 in 10 cases,and 9 in 21 cases.The AR product was related to age,pathological type,histological grade,Ki-67 and TNM.TNM and AR were independent influencing factors of disease-free survival(DFS).The PI formula was established as PI=-0.535 x AR product+BTNM.The PI of each patient was calculated and divided into three groups:low risk group(PI<-3,45 cases),medium risk group(-3≤PI<0,114 cases),high risk group(PI≥0,17 cases).There were significant differences in DFS and overall survival(OS)among the three groups.A nomogram was drawn to predict the 3-year and 5-year DFS.The C index of the nomogram was 0.719,and the correction curve indicated that the predicted value and the actual result basically coincide,which means the nomogram had a good prediction ability.Conclusion AR positive indicates a better prognosis in TNBC patients.By using AR and TNM,AR and TNM can be used to build the prognosis model of TNBC patients,which can more accurately predict the prognosis.
出处
《浙江临床医学》
2021年第1期11-14,共4页
Zhejiang Clinical Medical Journal
基金
浙江省医学会临床科研基金项目(2018ZYC-A90)
嘉兴市科技计划项目(2017AY33002)。
关键词
三阴性乳腺癌
雄激素受体
预后模型
Triple-negative breast cancer
Androgen receptor
Prognostic model
