Development and validation of a nomogram for predicting internal mammary sentinel node metastasis in breast cancer patients

作者全名："Qiu, Peng-Fei; Lv, Qing; Zhao, Wen-He; Huang, Yuan-Xi; Zhu, Shi-Guang; Zhong, Hong; Yang, Guang-Lun; Bell, Steven; Wang, Li-Yang; Xu, Ying-Ying; Sun, Xiao; Chen, Yu-Guang; Ding, Qiang; Wang, Yong-Sheng"

作者地址："[Qiu, Peng-Fei; Ding, Qiang] Nanjing Med Univ, Affiliated Hosp 1, Nanjing 210029, Jiangsu, Peoples R China; [Qiu, Peng-Fei; Sun, Xiao; Chen, Yu-Guang; Wang, Yong-Sheng] Shandong First Med Univ & Shandong Acad Med Sci, Shandong Canc Hosp & Inst, Breast Canc Ctr, Jinan 250117, Shandong, Peoples R China; [Lv, Qing] Sichuan Univ, West China Hosp, Dept Breast Surg, Chengdu 610041, Sichuan, Peoples R China; [Zhao, Wen-He] Zhejiang Univ, Sir Run Run Shaw Hosp, Coll Med, Dept Surg Oncol, Hangzhou 310020, Zhejiang, Peoples R China; [Huang, Yuan-Xi] Harbin Med Univ Canc Hosp, Dept Breast Surg, Harbin 150081, Heilongjiang, Peoples R China; [Zhu, Shi-Guang] Yantai Yuhuangding Hosp, Dept Breast Surg, Yantai 264001, Shandong, Peoples R China; [Zhong, Hong] Xinjiang Med Univ, Affiliated Teaching Hosp 3, Affiliated Canc Hosp, Dept Breast & Thyroid Surg, Urumqi 830011, Xinjiang, Peoples R China; [Yang, Guang-Lun] Chongqing Med Univ, Affiliated Hosp 1, Dept Endocrine Surg, 40016, Chongqing, Peoples R China; [Bell, Steven] Univ Cambridge, Precis Breast Canc Inst, Dept Oncol, Cambridge CB2 0QQ, England; [Wang, Li-Yang] Cambridge Univ Hosp NHS Fdn Trust, Cambridge Breast Unit, Cambridge CB2 0QQ, England; [Xu, Ying-Ying] China Med Univ, Affiliated Hosp 1, Dept Breast Surg, Shenyang 110001, Liaoning, Peoples R China; [Wang, Yong-Sheng] Shandong First Med Univ & Shandong Acad Med Sci, Shandong Canc Hosp & Inst, 440 Jiyan Rd, Jinan 250117, Shandong, Peoples R China; [Ding, Qiang] Nanjing Med Univ, Affiliated Hosp 1, Jiangsu Breast Dis Ctr, 300 Guangzhou Rd, Nanjing 210029, Jiangsu, Peoples R China"

通信作者："Wang, YS (通讯作者)，Shandong First Med Univ & Shandong Acad Med Sci, Shandong Canc Hosp & Inst, 440 Jiyan Rd, Jinan 250117, Shandong, Peoples R China.; Ding, Q (通讯作者)，Nanjing Med Univ, Affiliated Hosp 1, Jiangsu Breast Dis Ctr, 300 Guangzhou Rd, Nanjing 210029, Jiangsu, Peoples R China."

来源：EJSO

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:001073439400001

JCR分区：Q1

影响因子：3.5

年份：2023

卷号：49

期号：10

开始页：　

结束页：　

文献类型：Article

关键词：Breast cancer; Internal mammary node; Sentinel node biopsy; Nomogram

摘要："Objective: Internal mammary nodes are important in breast cancer prognosis, but their diagnosis is often missed in clinical practice, leading to inaccurate staging and treatment. We developed a validated nomogram to predict the presence of internal mammary sentinel nodes (IMSN) metastasis.Methods: A total of 864 sequential IMSN biopsy procedures from a prospective studies database of 1505 cases were used for model development and validation. Multivariable logistic regression was performed on 519 sequential IMSN biopsy procedures from multi-center data between August 2018 and July 2022 to predict the presence of IMSN metastasis. A nomogram was developed based on the logistic regression model and subsequently applied to 345 sequential IMSN biopsy procedures from single-center data between November 2011 and July 2018. The model's discrimination was assessed using the area under the receiver operating characteristic curve.Results: The overall frequency of IMSN metastasis was 17.0% in our study. A predictive model for IMSN metastasis was constructed using tumor size, tumor location, lymphovascular invasion, the number of positive axillary nodes (P < 0.05 for all variables in multivariate analysis), and histological grade (P < 0.05 only in univariate analysis). The nomogram was accurate, with a concordance index of 0.84 in the bootstrapping analysis and an area under the receiver operating characteristic curve of 0.80 in the validation population.Conclusion: Our nomogram provides an accurate and validated multivariable predictive model for estimating the individual likelihood of having IMSN metastasis. This may be useful for personalized treatment decisions regarding internal mammary radiotherapy in breast cancer patients."

基金机构：National Natural Science Foundation of China [82172873]; China Postdoctoral Science Foundation [2021M691334]; National Natural Science Foundation of Shandong Province [ZR2021QH002]

基金资助正文："This work was supported by the National Natural Science Foundation of China (82172873), China Postdoctoral Science Foundation (2021M691334) and National Natural Science Foundation of Shandong Province (ZR2021QH002)."