切换至 "中华医学电子期刊资源库"
高级检索
中华乳腺病杂志(电子版)

中华乳腺病杂志(电子版) ›› 2022, Vol. 16 ›› Issue (06) : 327 -335. doi: 10.3877/cma.j.issn.1674-0807.2022.06.001

论著

浸润性乳腺癌患者前哨及非前哨淋巴结转移的风险评估模型
袁思敏1, 王雪莹2, 谢湘莹3, 符德元2, 章佳新2,†()   
  1. 1. 116000　大连医科大学研究生院；225000　扬州，江苏省苏北人民医院甲状腺乳腺外科
    2. 225000　扬州，江苏省苏北人民医院甲状腺乳腺外科
    3. 430060　武汉大学人民医院护理部
  • 收稿日期:2022-03-31 出版日期:2022-12-01
  • 通信作者: 章佳新
  • 基金资助:
    国家自然科学基金面上项目(82072909)

Risk assessment model for sentinel lymph node and non-sentinel lymph node metastases in patients with invasive breast cancer

Simin Yuan1, Xueying Wang2, Xiangying Xie3, Deyuan Fu2, Jiaxin Zhang2,†()   

  1. 1. Graduate School, Dalian Medical University, Dalian 116000, China; Department of Thyroid and Breast Surgery, North Jiangsu People’s Hospital, Yangzhou 225000, China
    2. Department of Thyroid and Breast Surgery, North Jiangsu People’s Hospital, Yangzhou 225000, China
    3. Department of Nursing, People’s Hospital of Wuhan University, Wuhan 430060, China
  • Received:2022-03-31 Published:2022-12-01
  • Corresponding author: Jiaxin Zhang
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

袁思敏, 王雪莹, 谢湘莹, 符德元, 章佳新. 浸润性乳腺癌患者前哨及非前哨淋巴结转移的风险评估模型[J]. 中华乳腺病杂志(电子版), 2022, 16(06): 327-335.

Simin Yuan, Xueying Wang, Xiangying Xie, Deyuan Fu, Jiaxin Zhang. Risk assessment model for sentinel lymph node and non-sentinel lymph node metastases in patients with invasive breast cancer[J]. Chinese Journal of Breast Disease(Electronic Edition), 2022, 16(06): 327-335.

目的

探讨浸润性乳腺癌患者前哨及非前哨淋巴结转移的危险因素，建立可视化的列线图模型，指导临床腋窝处理。

方法

回顾性分析2017—2020年就诊于江苏省苏北人民医院甲状腺乳腺外科经病理证实的497例浸润性乳腺癌患者。所有患者均行前哨淋巴结活组织检查。用单因素和多因素Logistic回归分析筛选前哨及非前哨淋巴结转移的危险因素。通过R(4.1.0)软件绘制列线图模型和受试者操作特征(ROC)曲线，并计算曲线下面积(AUC)，通过rms包中的Calibrate函数来创建校准曲线，检验模型的预测效果。

结果

497例患者中，前哨淋巴结转移221例(44.5%)，均行腋窝淋巴结清扫术(ALND)，术后常规病理检查证实非前哨淋巴结转移141例。单因素分析表明，白蛋白与球蛋白比值(Z＝－2.000，P＝0.046)、外周血中性粒细胞与淋巴细胞比值(NLR)(Z＝－2.137，P＝0.033)、组织学分级(Z＝－5.168, P<0.001)、脉管内癌栓(χ2＝114.010，P<0.001)、HER-2(χ2＝3.989，P＝0.046)、Ki-67(χ2＝6.860，P＝0.009)、肿块位置(χ2＝72.593，P<0.001)与前哨淋巴结转移相关；多因素分析结果表明组织学分级(1级与3级比较：OR＝3.167, 95%CI：1.201~8.356，P＝0.002)、脉管内癌栓(OR＝2.210, 95%CI：5.487~15.142，P<0.001)、肿块位置(外上与内上象限比较：OR＝0.133，95%CI：0.063~0.281，P<0.001)是前哨淋巴结转移的独立预测因素。将221例行ALND的患者分为非前哨转移组及未转移组。单因素分析表明肿块大小(χ2＝9.406，P＝0.002)、外周血中性粒细胞计数(Z＝－2.248，P＝0.025)、组织学分级(Z＝－3.270，P＝0.001)及脉管内癌栓(χ2＝12.959，P<0.001)与患者非前哨淋巴结转移相关；多因素分析表明肿块大小(OR＝2.600, 95%CI：1.420~4.760，P＝0.002)、脉管内癌栓(OR＝2.968, 95%CI：1.640~5.369，P<0.001)及外周血中性粒细胞计数(OR＝1.336, 95%CI：1.060~1.684，P＝0.014)是非前哨淋巴结转移的独立预测因素。前哨及非前哨淋巴结转移的ROC曲线显示：AUC面积分别为0.828(95%CI：0.793~0.865)及0.712(95%CI：0.642－0.782)。Calibration校准曲线的C-index依次为0.828和0.712，与实际结果有较好的一致性。

结论

该列线图模型能较好地预测前哨及非前哨淋巴结转移的概率，有利于临床腋窝的精细化处理。

关键词: 乳腺肿瘤, 前哨淋巴结, 列线图
Objective

To investigate the risk factors for sentinel lymph node and non-sentinel lymph node metastasis in patients with invasive breast cancer, establish a visual nomogram model and guide clinical axillary management.

Methods

A retrospective analysis was performed in 497 patients with pathologically confirmed invasive breast cancer in the Department of Thyroid and Breast Surgery, North Jiangsu People’s Hospital from 2017 to 2020. Sentinel lymph node biopsy is performed in all patients. Univariate and multivariate logistic regression analysis was used to screen risk factors for sentinel and non-sentinel lymph node metastasis. The nomogram model and receiver operating characteristic (ROC) curve were drawn by the R 4.1.0 software, and the area under the curve (AUC) was calculated, and the calibration curve was created by the Calibrate function in the rms package to test the predictive effect of the model.

Results

Among 497 patients, 221 (44.5%) had sentinel lymph node metastasis and they all underwent axillary lymph node dissection (ALND). Among them, 141 cases had non-sentinel lymph node metastasis confirmed by routine pathological examination after surgery. Univariate analysis showed that albumin-to-globulin ratio (Z=-2.000, P=0.046), peripheral blood neutrophil-to-lymphocyte ratio (NLR) (Z=-2.137, P=0.033), histological grade (Z=-5.168, P<0.001), intravascular cancer thrombus (χ2=114.010, P<0.001), HER-2 (χ2=3.989, P=0.046), Ki-67 (χ2=6.860, P=0.009), mass location (χ2=72.593, P<0.001) were related to sentinel lymph node metastasis. Multivariate analysis showed that histological grade (grade 3 vs grade 1: OR=3.167, 95%CI: 1.201-8.356, P=0.002), intravasculature cancer thrombus (OR=9.115, 95%CI: 5.487-15.142, P<0.001), and mass location (upper outer quadrant vs upper inner quadrant: OR=0.133, 95%CI: 0.063-0.618, P<0.001) were independent predictors of sentinel lymph node metastasis. The 221 patients receiving ALND were divided into non-sentinel node metastatic group and non-metastatic group. Univariate analysis showed that lump size (χ2=9.406, P=0.002), peripheral blood neutrophil count (Z=-2.248, P=0.025), histological grade (Z=-3.270, P=0.001) and intravascular cancer thrombus (χ2=12.959, P<0.001) were related to non-sentinel lymph node metastasis. Multivariate analysis showed that mass size (OR=2.600, 95%CI: 1.420-4.760, P=0.002), intravascular cancer thrombus (OR=2.968, 95%CI: 1.640-5.369, P<0.001) and peripheral blood neutrophil count (OR=1.336, 95%CI: 1.060-1.684, P=0.014) were independent predictors of non-sentinel lymph node metastasis. The AUC of ROC curve was 0.828 (95%CI: 0.793-0.865) for sentinel lymph node and 0.712 (95%CI: 0.642-0.782) for non-sentinel lymph node metastasis. The C-index of the calibration curve was 0.828 for sentinel lymph node and 0.712 for non-sentinel lymph node metastasis, indicating high consistence with the actual results.

Conclusion

The nomogram model can predict the probability of sentinel and non-sentinel lymph node metastasis, providing guidance for precision axillary treatment in clinic.

Key words: Breast neoplasms, Sentinel lymph nodes, Nomograms
表1 浸润性乳腺癌患者前哨及非前哨淋巴结转移危险因素多因素分析变量赋值表
变量 变量名 赋值
组织学分级 X1 1级＝1; 2级＝2; 3级＝3
脉管内癌栓 X2 无癌栓＝1；有癌栓＝2
肿块大小 X3 ≤2 cm＝1；>2 cm＝2
ER X4 阴性＝1；阳性＝2
PR X5 阴性＝1；阳性＝2
HER-2 X6 阴性＝1；阳性＝2
Ki-67 X7 低表达＝1；高表达＝2
分子分型 X8 luminal型＝1；HER-2阳性型＝2；三阴型＝3
肿块位置 X9 外上象限＝1；外下象限＝2；内下象限＝3；内上象限＝4
前哨淋巴结转移 Y1 未转移＝0；转移＝1
非前哨淋巴结转移 Y2 未转移＝0；转移＝1
表2 497例浸润性乳腺癌患者前哨淋巴结转移的单因素分析结果
临床病理特征 前哨淋巴结未转移(n＝276) 前哨淋巴结转移(n＝221) 检验值 P值
年龄(岁，±s) 52.64±10.22 52.39±9.65 t＝0.280 0.779
白蛋白/球蛋白[M(P25，P75)] 1.72(1.56，1.97) 1.77(1.61，2.00) Z＝－2.000 0.046
PLR[M(P25，P75)] 128.79(105.41，164.09) 123.20(95.40，156.43) Z＝－1.600 0.110
NLR[M(P25，P75)] 2.37(1.77，3.07) 2.15(1.57，2.98) Z＝－2.137 0.033
中性粒细胞计数[×109/L, M(P25，P75)] 3.89(2.94，4.70) 3.72(2.83，4.58) Z＝－1.215 0.225
淋巴细胞数目[×109/L, M(P25，P75)] 1.62(1.32，2.03) 1.68(1.33，2.13) Z＝－1.118 0.263
血小板数目(×109/L, ±s) 216.42±59.37 211.53±62.01 t＝0.894 0.372
组织学分级[例(%)]        
  1级 30(10.9) 6(2.7) Z＝－5.168 <0.001
  2级 111(40.2) 59(26.7)
  3级 135(48.9) 156(70.6)
脉管内癌栓[例(%)]        
  有 29(10.5) 121(54.8) χ2＝114.010 <0.001
  无 247(89.5) 100(45.2)
肿块大小[例(%)]        
  ≤2 cm 177(64.1) 132(59.7) χ2＝1.011 0.315
  >2 cm 99(35.9) 89(40.3)
ER[例(%)]        
  阴性 97(35.1) 89(40.3) χ2＝1.377 0.241
  阳性 179(64.9) 132(59.7)
PR[例(%)]        
  阴性 135(48.9) 112(50.7) χ2＝0.153 0.696
  阳性 141(51.1) 109(49.3)
HER-2[例(%)]        
  阴性 205(74.3) 146(66.1) χ2＝3.989 0.046
  阳性 71(25.7) 75(33.9)
Ki-67[例(%)]        
  低表达 102(37.0) 57(25.8) χ2＝6.860 0.009
  高表达 174(63.0) 164(74.2)
分子分型[例(%)]        
  luminal型 155(56.2) 102(46.2) χ2＝5.600 0.061
  HER-2阳性型 70(25.4) 75(33.9)
  三阴型 51(18.4) 44(19.9)
肿块位置[例(%)]        
  外上象限 77(27.9) 143(64.7) χ2＝72.593 <0.001
  外下象限 51(18.4) 30(13.6)
  内下象限 91(33.0) 35(15.8)
  内上象限 57(20.7) 13(5.9)
表3 497例浸润性乳腺癌患者前哨淋巴结转移的多因素分析结果
临床病理特征 β值 Wald Z值 P值 OR值 95%置信区间
脉管内癌栓 2.210 72.817 <0.001 9.115 5.487~15.142
组织学分级          
  1级(参照) － － － － －
  2级 0.433 0.716 0.387 1.542 0.556~4.204
  3级 1.153 5.425 0.002 3.167 1.201~8.356
肿块位置          
  外上象限(参照) － － － － －
  外下象限 －1.084 12.401 <0.001 0.338 0.185~0.618
  内下象限 －1.554 29.488 <0.001 0.211 0.121~0.370
  内上象限 －2.015 28.094 <0.001 0.133 0.063~0.281
表4 221例浸润性乳腺癌患者非前哨淋巴结转移的单因素分析结果
临床病理特征 非前哨淋巴结未转移(n＝80) 非前哨淋巴结转移(n＝141) 检验值 P值
年龄(岁，±s) 50.80±8.30 53.29±10.26 t＝－1.854 0.065
白蛋白/球蛋白[M(P25，P75)] 1.76(1.62，1.98) 1.80(1.61，2.01) Z＝－0.486 0.627
PLR[M(P25，P75)] 136.45(106.61，172.00) 125.36(99.79，158.65) Z＝－1.417 0.156
NLR[M(P25，P75)] 2.26(1.77，3.01) 2.37(1.66，3.09) Z＝－0.726 0.468
中性粒细胞计数[×109/L, M(P25，P75)] 3.69(2.72，4.43) 4.00(3.02，4.86) Z＝－2.248 0.025
淋巴细胞数目[×109/L, M(P25，P75)] 1.60(1.27，2.05) 1.61(1.32，2.12) Z＝－1.158 0.247
血小板数目(×109/L, ±s) 223.83±60.91 211.26±60.12 t＝1.486 0.139
组织学分级[例(%)]        
  1级 4(5.0) 2(1.4) Z＝－3.270 0.001
  2级 30(37.5) 29(20.6)
  3级 46(57.5) 110(40.4)
脉管内癌栓[例(%)]        
  有 31(38.8) 90(63.8) χ2＝12.959 <0.001
  无 49(61.2) 51(36.2)
肿块大小[例(%)]        
  ≤2 cm 54(67.5) 65(46.1) χ2＝9.406 0.002
  >2 cm 26(32.5) 76(53.9)
ER[例(%)]        
  阴性 28(35.0) 61(43.3) χ2＝1.449 0.229
  阳性 52(65.0) 80(56.7)
PR[例(%)]        
  阴性 34(42.5) 78(55.3) χ2＝3.356 0.067
  阳性 46(57.5) 63(44.7)
HER-2[例(%)]        
  阴性 52(65.0) 94(66.7) χ2＝0.063 0.801
  阳性 28(35.0) 47(33.3)
Ki-67[例(%)]        
  低表达 24(30.3) 33(23.4) χ2＝1.283 0.257
  高表达 56(69.7) 108(76.6)
分子分型[例(%)]        
  luminal型 39(48.8) 63(44.7) χ2＝1.068 0.586
  HER-2阳性型 28(35.0) 47(33.3)
  三阴型 13(16.2) 31(22.0)
肿块位置[例(%)]        
  外上象限 46(57.5) 97(68.8) χ2＝4.052 0.256
  外下象限 15(18.8) 15(10.6)
  内下象限 13(16.2) 22(15.6)
  内上象限 6(7.5) 7(5.0)
表5 221例浸润性乳腺癌患者非前哨淋巴结转移的多因素分析结果
临床病理特征 β值 Wald Z值 P值 OR值 95%置信区间
肿块大小 0.956 0.309 0.002 2.600 1.420~4.760
脉管内癌栓 1.088 12.933 <0.001 2.968 1.640~5.369
中性粒细胞计数 0.289 5.999 0.014 1.336 1.060~1.684
图1 497例浸润性乳腺癌患者前哨淋巴结转移的列线图模型
图2 221例浸润性乳腺癌患者非前哨淋巴结转移的列线图模型
图3 497例浸润性乳腺癌患者前哨淋巴结转移受试者操作特征曲线注：曲线下面积为0.828
图4 221例浸润性乳腺癌患者非前哨淋巴结转移的受试者操作特征曲线注：曲线下面积为0.712
图5 497例浸润性乳腺癌患者前哨淋巴结转移的Calibrate曲线注：当预测发生率与实际发生率完全一致，曲线恰好为对角线；当校准曲线位于对角线之上，预测发生率大于实际发生率；当校准曲线位于对角线之下，预测发生率小于实际发生率
图6 221例浸润性乳腺癌患者非前哨淋巴结转移的Calibrate曲线注：当预测发生率与实际发生率完全一致，曲线恰好为对角线；当校准曲线位于对角线之上，预测发生率大于实际发生率；当校准曲线位于对角线之下，预测发生率小于实际发生率
[31]
Mantovani A, Allavena P, Sica A, et al. Cancer-related inflammation [J]. Nature, 2008, 454(7203): 436-444.
[32]
Trinchieri G. Cancer and inflammation: an old intuition with rapidly evolving new concepts [J]. Annu Rev Immunol, 2012, 30: 677-706.
[33]
梅章懿，蒋蓓琦，安敏，等. 中性粒细胞淋巴细胞比及血小板淋巴细胞比预测乳腺癌非前哨淋巴结转移的价值分析 [J]. 现代肿瘤医学，2021, 29(6): 955-960.
[34]
Mlkami Y, Yamada A, Suzuki C, et al. Predicting nonsentinel lymph node metastasis in breast cancer: a multicenter retrospective study [J]. J Surg Res, 2021, 264: 45-50.
[35]
Thangarajah F, Malter W, Hamacher S, et al. Predictors of sentinel lymph node metastases in breast cancer-radioactivity and Ki-67[J]. Breast, 2016, 30: 87-91.
[36]
Malter W, Hellmich M, Badian M, et al. Factors predictive of sentinel lymph node involvement in primary breast cancer [J]. Anticancer Res, 2018, 38(6): 3657-3662.
[37]
杨丽，朱荔，马金平，等. 乳腺癌前哨淋巴结与非前哨淋巴结转移危险因素分析[J]. 中华肿瘤防治杂志，2019, 26(22): 1726-1731.
[38]
Zhang W, Fang M, Dong D, et al. Development and validation of a CT-based radiomic nomogram for preoperative prediction of early recurrence in advanced gastric cancer [J]. Radiother Oncol, 2020, 145: 13-20.
[39]
Yu C, Zhang Y. Establishment of prognostic nomogram for elderly colorectal cancer patients: a SEER database analysis [J]. BMC Gastroenterol, 2020, 20(1): 347.
[1]
Sung H, Ferlay J, Siege RL, et al. Global cancer statistics 2020: Globocan estimates of incidence and mortality worldwide for 36 cancers in 185 countries [J]. CA Cancer J Clin, 2021, 71(3): 209-249.
[2]
Halsted WS. I. The results of operations for the cure of cancer of the breast performed at the Johns Hopkins Hospital from June, 1889, to January, 1894 [J]. Ann Surg, 1894, 20(5): 497-555.
[3]
Jones C, Lancaster R. Evolution of operative technique for mastectomy [J]. Surg Clin North Am, 2018, 98(4): 835-844.
[4]
Ahmed M, Purushotham AD, Douek M. Novel techniques for sentinel lymph node biopsy in breast cancer: a systematic review [J]. Lancet Oncol, 2014, 15(8): e351-362.
[5]
Ang CH, Tan MY, Teo C, et al. Blue dye is sufficient for sentinel lymph node biopsy in breast cancer [J]. Br J Surg, 2014, 101(4): 383-389.
[6]
Giuliano AE, Ballman KV, Mccall L, et al. Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: the ACOSOG Z0011 (Alliance) randomized clinical trial [J]. JAMA, 2017, 318(10): 918-926.
[7]
Chu KU, Turner RR, Hansen NM, et al. Do all patients with sentinel node metastasis from breast carcinoma need complete axillary node dissection? [J]. Ann Surg, 1999, 229(4): 536-541.
[8]
Rouzier R, Uzan C, Rousseau A, et al. Multicenter prospective evaluation of the reliability of the combined use of two models to predict non-sentinel lymph node status in breast cancer patients with metastatic sentinel lymph nodes: the MSKCC nomogram and the Tenon score. Results of the NOTEGS study [J]. Br J Cancer, 2017, 116(9): 1135-1140.
[9]
Barranger E, Coutant C, Flahault A, et al. An axilla scoring system to predict non-sentinel lymph node status in breast cancer patients with sentinel lymph node involvement [J]. Breast Cancer Res Treat, 2005, 91(2): 113-119.
[10]
Van Zee KJ, Manasseh DM, Bevilacqua JL, et al. A nomogram for predicting the likelihood of additional nodal metastases in breast cancer patients with a positive sentinel node biopsy [J]. Ann Surg Oncol, 2003, 10(10): 1140-1151.
[11]
曹迎明，刘淼，周波，等. MSKCC和SOC模型预测中国乳腺癌患者非前哨淋巴结转移的验证比较研究 [J]. 中国肿瘤临床，2014, 41(8): 508-512.
[12]
中国临床肿瘤学会指南工作委员会. 乳腺癌诊疗指南 [M]. 北京：人民卫生出版社，2022.
[13]
Hanley JA, Mcneil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve [J]. Radiology, 1982, 143(1): 29-36.
[14]
Carter CL, Allen C, Henson DE. Relation of tumor size, lymph node status, and survival in 24，740 breast cancer cases [J]. Cancer, 1989, 63(1): 181-187.
[15]
Yoshihara E, Smeets A, Laenen A, et al. Predictors of axillary lymph node metastases in early breast cancer and their applicability in clinical practice [J]. Breast, 2013, 22(3): 357-361.
[16]
Mansel RE, Fallowfield L, Kissin M, et al. Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the Almanac Trial [J]. J Natl Cancer Inst, 2006, 98(9): 599-609.
[17]
姜军，王殊. 乳腺癌荧光示踪前哨淋巴结活组织检查操作指南 [J/CD]. 中华乳腺病杂志(电子版), 2017, 11(4): 193-197.
[18]
张崇建. 河南省肿瘤诊疗质量控制中心早期乳腺癌手术治疗专家共识 [J]. 中华肿瘤防治杂志，2021, 28(22): 1683-1687.
[19]
Mclaughlin SA, Wright MJ, Morris KT, et al. Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: objective measurements [J]. J Clin Oncol, 2008, 26(32): 5213-5219.
[20]
Galimberti V, Cole BF, Viale G, et al. Axillary dissection versus no axillary dissection in patients with breast cancer and sentinel-node micrometastases (IBCSG 23-01): 10-year follow-up of a randomised, controlled phase 3 trial [J]. Lancet Oncol, 2018, 19(10): 1385-1393.
[21]
梁晨露，李鏐祎，竺美珍，等. 结合前哨淋巴结冰冻检测阳性数免除早期乳腺癌腋窝清扫的可行性分析 [J]. 肿瘤学杂志，2021, 27(7): 526-530.
[22]
Claus EB, Risch NJ, Thompson WD. Age at onset as an indicator of familial risk of breast cancer [J]. Am J Epidemiol, 1990, 131(6): 961-972.
[23]
Liszkay G, Mátrai Z, Czirbesz K, et al. Predictive and prognostic value of Braf and Nras mutation of 159 sentinel lymph node cases in melanoma-a retrospective single-institute study [J]. Cancers (Basel), 2021, 13(13)：3302.
[24]
Hennigs A, Köpke M, Feißt M, et al. Which patients with sentinel node-positive breast cancer after breast conservation still receive completion axillary lymph node dissection in routine clinical practice? [J]. Breast Cancer Res Treat, 2019, 173(2): 429-438.
[25]
Jaka RC, Zaveri SS, Somashekhar SP, et al. Value of frozen section and primary tumor factors in determining sentinel lymph node spread in early breast carcinoma [J]. Indian J Surg Oncol, 2010, 1(1): 27-36.
[26]
Lee JH, Kim SH, Suh YJ, et al. Predictors of axillary lymph node metastases (ALNM) in a Korean population with T1-2 breast carcinoma: triple negative breast cancer has a high incidence of ALNM irrespective of the tumor size [J]. Cancer Res Treat, 2010, 42(1): 30-36.
[27]
Verheuvel NC, Voogd AC, Tjan-heijne VG, et al. Non-visualized sentinel nodes in breast cancer patients; prevalence, risk factors, and prognosis [J]. Breast Cancer Res Treat, 2018, 167(1): 147-156.
[28]
Holm-rasmussen EV, Jensen MB, Balslev E, et al. Risk factors of sentinel and non-sentinel lymph node metastases in patients with ductal carcinoma in situ of the breast: A nationwide study [J]. Breast, 2018, 42: 128-132.
[29]
Ding J, Jiang L, Wu W. Predictive value of clinicopathological characteristics for sentinel lymph node metastasis in early breast cancer [J]. Med Sci Monit, 2017, 23: 4102-4108.
[30]
Grivennikov SI, Greten FR, Karin M. Immunity, inflammation, and cancer [J]. Cell, 2010, 140(6): 883-899.
[1] 郏亚平, 曾书娥. 含鳞状细胞癌成分的乳腺化生性癌的超声与病理特征分析[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 844-848.
[2] 邵华, 那子悦, 荆慧, 李博, 王秋程, 程文. 术前经皮超声造影对乳腺癌腋窝前哨淋巴结转移及负荷的诊断价值[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 849-853.
[3] 孙帼, 谢迎东, 徐超丽, 杨斌. 超声联合临床特征的列线图模型预测甲状腺乳头状癌淋巴结转移的价值[J]. 中华医学超声杂志（电子版）, 2023, 20(07): 734-742.
[4] 唐玮, 何融泉, 黄素宁. 深度学习在乳腺癌影像诊疗和预后预测中的应用[J]. 中华乳腺病杂志(电子版), 2023, 17(06): 323-328.
[5] 康夏, 田浩, 钱进, 高源, 缪洪明, 齐晓伟. 骨织素抑制破骨细胞分化改善肿瘤骨转移中骨溶解的机制研究[J]. 中华乳腺病杂志(电子版), 2023, 17(06): 329-339.
[6] 衣晓丽, 胡沙沙, 张彦. HER-2低表达对乳腺癌新辅助治疗疗效及预后的影响[J]. 中华乳腺病杂志(电子版), 2023, 17(06): 340-346.
[7] 施杰, 李云涛, 高海燕. 腋窝淋巴结阳性Luminal A型乳腺癌患者新辅助与辅助化疗的预后及影响因素分析[J]. 中华乳腺病杂志(电子版), 2023, 17(06): 353-361.
[8] 伍秋苑, 陈佩贤, 邓裕华, 何添成, 周丹. 肠道微生物在乳腺癌中的研究进展[J]. 中华乳腺病杂志(电子版), 2023, 17(06): 362-365.
[9] 谭巧, 苏小涵, 侯令密, 黎君彦, 邓世山. 乳腺髓样癌的诊治进展[J]. 中华乳腺病杂志(电子版), 2023, 17(06): 366-368.
[10] 周婉丽, 钱铮, 李喆. 槐耳在乳腺癌免疫治疗中的研究进展[J]. 中华乳腺病杂志(电子版), 2023, 17(06): 369-371.
[11] 熊倩, 罗凤. 乳腺癌患者术后康复现状与对策的研究进展[J]. 中华乳腺病杂志(电子版), 2023, 17(06): 372-374.
[12] 唐旭, 韩冰, 刘威, 陈茹星. 结直肠癌根治术后隐匿性肝转移危险因素分析及预测模型构建[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 16-20.
[13] 甄子铂, 刘金虎. 基于列线图模型探究静脉全身麻醉腹腔镜胆囊切除术患者术后肠道功能紊乱的影响因素[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 61-65.
[14] 晏晴艳, 雍晓梅, 罗洪, 杜敏. 成都地区老年转移性乳腺癌的预后及生存因素研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 636-638.
[15] 李智铭, 郭晨明, 庄晓晨, 候雪琴, 高军喜. 早期乳腺癌超声造影定性及定量指标的对比研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 639-643.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号