摘要
Abstract
Objective To explore the risk factors influencing the prognosis of breast cancer and establish a predictive model by analyzing the ultrasound,contrast-enhanced ultrasound,clinical and pathological data of breast cancer patients.Methods A cohort of 365 breast cancer patients diagnosed by needle biopsy and postoperative pathological examination at the First Affiliated Hospital of Xinjiang Medical University from January 2014 to January 2022 was stratified and analyzed according to prognostic outcomes.The cohort comprised 302 patients without distant metastasis who survived,and 63 patients who either developed distant metastasis or succumbed to the disease.The follow-up duration ranged from a minimum of 36 months to a maximum of 96 months,with an average follow-up time of 48.2 months.Univariate and multivariate Cox regression analyses were conducted to evaluate the impact of ultrasound findings,contrast-enhanced ultrasound results,and clinical risk factors on the prognosis of breast cancer patients.According to the ratio of 7:3,365 breast cancer cases were randomly divided into a training set(n=256)and a validation set(n=109).The model was visualized and plotted using a line graph and survival curve with the R software;the ROC curve was drawn and the area under the curve(AUC)was calculated;the accuracy of the prediction was evaluated using the calibration curve;and the clinical benefit of the model was quantified using the decision curve analysis.Results The patient had a family history(P<0.001),the maximum diameter of the lesion was≥3 cm(P<0.001),axillary lymph node metastasis(P<0.001),contrast-enhanced ultrasound had peripheral convergence phenomenon(P<0.001),and the enhancement amplitude(P=0.036),the area under the time-intensity curve after enhancement(P=0.005),chemotherapy status(P<0.001),and triple-negative molecular subtype(P<0.001)between the two groups of patients were statistically significant.Chemotherapy status(P=0.047),the maximum diameter of the lesion≥3 cm(P=0.002),contrast-enhanced ultrasound with peripheral convergence phenomenon(P=0.002),and the tumor molecular subtype being triple-negative(P=0.009)were independent risk factors affecting distant metastasis or death events in breast cancer patients.Based on the screened independent risk factors,a Nomogram was established.The predicted AUCs of distant metastasis-free survival rates in the model training set at 3 and 5 years were 0.80 and 0.84,respectively,and those in the validation set at 3-and 5-years were 0.77 and 0.80,respectively.Conclusion A prognostic model for predicting 3-year and 5-year survival rate of breast cancer patients without distant metastasis was established based on ultrasound,contrast-enhanced ultrasound,clinical and pathological data.The model shows good results in predicting the prognosis of breast cancer patients,and it could have a positive impact on the decision making of clinicians.关键词
超声造影/乳腺癌/列线图/预后模型Key words
contrast-enhanced ultrasound/breast cancer/Nomogram/prognostic model
