基于入院临床资料的保乳术后乳腺癌复发风险预测模型构建与验证

Development and validation of a risk prediction model for tumor recurrence after breast-conserving surgery based on admission clinical data

摘要:

背景与目的 保乳术作为乳腺癌的重要手术方式，兼顾肿瘤切除与乳腺组织保留，已广泛应用于临床。然而，术后肿瘤复发仍是影响患者预后的关键问题，亟须精准的风险预测工具以指导个体化治疗。本研究旨在基于入院临床资料构建保乳术后肿瘤复发的风险预测模型，并验证其预测效能，期望为临床提供科学、便捷的决策支持。方法 纳入南阳医学高等专科学校第一附属医院2017年5月—2019年5月接受保乳术的224例乳腺癌患者，随访统计复发情况。采用多因素Logistic回归分析筛选影响复发的独立危险因素，构建风险预测模型，并通过受试者工作特征曲线（ROC）评估模型的区分度，Calibration曲线验证其校准能力。结果 最终208例患者完成随访，随访时间32~84个月，平均（58.41±7.33）个月，复发率为17.79%。多因素Logistic回归分析显示，TNM分期Ⅲ期（OR=2.029）、肿瘤直径≥4 cm（OR=1.782）、淋巴结转移数量≥4枚（OR=1.958）、脉管癌栓（OR=1.984）及HER2阳性（OR=1.774）为复发的独立危险因素（均P<0.05）。据此建立的Logistic回归模型公式为：Y=-12.788+0.707X?+0.578X?+0.672X?+0.685X?+0.573X?。模型ROC曲线下面积为0.934（95% CI=0.891~0.963），敏感度为86.49%，特异度为96.49%。Calibration曲线显示模型校准良好（χ²=0.501，P=0.392）。结论 TNM分期Ⅲ期、肿瘤直径≥4 cm、淋巴结转移数量≥4枚、脉管癌栓及HER2阳性是保乳术后肿瘤复发的独立危险因素。基于这些指标构建的风险预测模型具有良好的区分度与校准能力，可为术后风险评估与临床干预提供参考依据。

Abstract:

Background and Aims Breast-conserving surgery, which balances tumor excision with preservation of breast tissue, has become a widely adopted surgical approach for breast cancer. However, postoperative tumor recurrence remains a major factor affecting patient prognosis. Accurate risk prediction tools are urgently needed to guide personalized treatment strategies. This study aimed to develop a risk prediction model for tumor recurrence after BCS based on admission clinical data and to evaluate its predictive performance to provide a scientific and practical tool for clinical decision-making.Methods A total of 224 breast cancer patients who underwent breast-conserving surgery between May 2017 and May 2019 were enrolled. Postoperative recurrence was recorded during follow-up. Multivariate Logistic regression analysis was used to identify independent risk factors for recurrence and to construct a risk prediction model. The model's discriminative ability was assessed using the receiver operating characteristic (ROC) curve, and its calibration was evaluated using a calibration curve.Results 208 patients completed follow-up, ranging from 32 to 84 months, with a mean duration of (58.41±7.33) months. The recurrence rate was 17.79%. Multivariate Logistic regression analysis revealed that TNM stage Ⅲ (OR=2.029), tumor diameter ≥4 cm (OR=1.782), ≥4 lymph node metastases (OR=1.958), lymphovascular invasion (OR=1.984), and HER2 positivity (OR=1.774) were independent risk factors for recurrence (all P<0.05). The Logistic regression model was established as follows: Y=-12.788+0.707X?+0.578X?+0.672X?+0.685X?+0.573X?. The model yielded an area under the ROC curve (AUC) of 0.934 (95% CI=0.891-0.963), with a sensitivity of 86.49% and specificity of 96.49%. The calibration curve demonstrated good agreement between predicted and observed outcomes (χ2=0.501, P=0.392).Conclusion TNM stage Ⅲ, tumor diameter ≥4 cm, ≥4 lymph node metastases, lymphovascular invasion, and HER2 positivity are independent risk factors for tumor recurrence after breast-conserving surgery. The risk prediction model based on these factors demonstrates favorable discrimination and calibration, offering valuable guidance for postoperative risk assessment and clinical intervention.