解放军医学杂志2025，Vol.50Issue(12)：1499-1507,9.DOI:10.11855/j.issn.0577-7402.2069.2025.0512
HER-2阳性乳腺癌新辅助治疗疗效不佳的影响因素分析及预测模型构建
Analysis of factors influencing poor efficacy of neoadjuvant therapy and construction of a prediction model for HER-2-positive breast cancer
摘要
Abstract
Objective To analyze the factors influencing poor efficacy of neoadjuvant therapy in patients with human epidermal growth factor receptor-2(HER-2)-positive breast cancer and to construct a nomogram predictive model.Methods Clinical data from 520 HER-2-positive breast cancer patients who underwent neoadjuvant therapy at the Chinese PLA General Hospital between January 2013 and June 2024 were retrospectively analyzed.Among them,data of 472 patients from the First Medical Center of the Chinese PLA General Hospital were used as the modeling set,and data of 48 patients from the Third and Sixth Medical Centers were used as the external validation set.In the modeling set,t-test,χ2 test,and LASSO regression were employed to preliminarily screen the influencing factors of poor neoadjuvant efficacy.The modeling set was randomly divided into a training set(n=377)and an internal validation set(n=95)at a ratio of 8:2.Univariate and multivariate analyses of factors influencing poor neoadjuvant efficacy were further performed in the training set.A logistic regression model was constructed based on the final screened factors,and a nomogram was drawn within the training set.The predictive performance and clinical benefits of the model were assessed through calibration curves and clinical decision curve analysis(DCA),which were verified and evaluated in the internal and external validation sets,respectively.Results In the modeling set,increased maximum preoperative tumor diameter,elevated estrogen receptor(ER)expression level,and increased axillary lymph node tumor staging(N-stage)were identified as independent factors increasing the risk of poor efficacy(P<0.05).Conversely,increased number of taxane-containing cycles in the neoadjuvant regimen,increased number of targeted therapy cycles in the neoadjuvant regimen,and HER-2 expression of(+++)were identified as independent factors reducing the risk of poor efficacy(P<0.05).A prediction model based on these 6 factors was developed,which achieved an area under the curve(AUC)of 0.88(95%CI 0.84-0.91)in the training set,0.88(95%CI 0.82-0.95)in the internal validation set,and 0.91(95%CI 0.83-0.99)in the external validation set.Calibration curves demonstrated good predictive accuracy,and DCA confirmed high clinical application value of the model.Conclusion The predictive model developed in this study can effectively predict the efficacy of neoadjuvant therapy in HER-2-positive breast cancer patients,providing a reference for individualized treatment.关键词
人类表皮生长因子受体-2/乳腺癌/新辅助治疗/疗效不佳/列线图Key words
human epidermal growth factor receptor-2/breast cancer/neoadjuvant therapy/poor efficacy/nomogram分类
医药卫生引用本文复制引用
Huang De-Qin,Liu Li-Qun,Chen Jia-Hai,Wang Mei-Ling,Luo Dan-Feng,Ma Xin-Ying,Xu Shi-Xing,Zhang Xun-Hao,Zhao Wei-Hong..HER-2阳性乳腺癌新辅助治疗疗效不佳的影响因素分析及预测模型构建[J].解放军医学杂志,2025,50(12):1499-1507,9.基金项目
This work was supported by the Basic Research Project for Military Applications(17BJZ40) 军队应用基础研究项目(17BJZ40) （17BJZ40）
