摘要： 目的 回顾性分析经曲妥珠单抗治疗的HER2阳性晚期乳腺癌患者生存数据，筛选与预后相关的临床病理因素，建立预后模型。方法 收集2002年12月至2018年12月中国医科大学附属第一医院肿瘤内科收治的经曲妥珠单抗治疗的HER2阳性晚期乳腺癌患者224例。建立HER2阳性晚期乳腺癌患者数据库并分析影响其预后的因素。数据分析与列线图模型的建立采用Cox风险比例模型、Kaplan-Meier曲线（log-rank检验）及一致性指数（C-index）。结果 激素受体（HR）状态（P=0.027），是否肝转移（P=0.038），一线治疗是否应用曲妥珠单抗（P=0.001）以及曲妥珠单抗治疗时长（P=0.028）是影响HER2阳性晚期乳腺癌患者复发后总体生存（OS）的独立预后因素。基于独立预后因素的OS列线图模型具有较好的分辨率，其C-index为0.779（95%CI：0.727~0.831，P < 0.001）。结论 HR状态、是否肝转移、一线治疗是否应用曲妥珠单抗以及曲妥珠单抗治疗时长是影响HER2阳性晚期乳腺癌患者复发后OS的主要因素。根据独立预后因素建立的列线图预后模型可相对准确地预测经曲妥珠单抗治疗的HER2阳性晚期乳腺癌患者的预后，指导个体化治疗。

基于HER2阳性晚期乳腺癌患者预后因素分析的回顾性研究及预后模型的建立

肖琦琪, 李智, 石晶, 赵雷, 魏翘楚, 滕月娥

中国医科大学附属第一医院肿瘤内科, 沈阳 110001

收稿日期:2020-03-31出版日期:2021-01-30发布日期:2021-01-06
通讯作者:滕月娥E-mail:yeteng@cmu.edu.cn
作者简介:肖琦琪(1989-),女,硕士研究生.



关键词: 曲妥珠单抗, HER2阳性乳腺癌, 预后, 列线图模型
Abstract: Objective To retrospectively analyze the survival of patients with HER2-positive advanced breast cancer who were treated with trastuzumab and to identify the clinicopathological factors related to prognosis in order to establish a prognostic model. Methods A total of 224 patients with advanced HER2-positive advanced breast cancer who had received trastuzumab treatment in the Department of Oncology,the First Hospital of China Medical University from December,2012 to December,2018 were screened for inclusion. A database of trastuzumab for HER2-positive advanced breast cancer patients was established,and the factors affecting prognosis were analyzed. The methods used for data analysis and nomogram prognostic model establishment included Cox risk proportional model,Kaplan-Meier curve (log-rank test),and Harrell's concordance index (C-index). Results The HR receptor status (P=0.027),presence of trastuzumab as the first-line drug (P=0.001),duration of anti-HER2 treatment (P=0.028),and liver metastasis (P=0.038) were independent prognostic factors affecting overall survival (OS) of the patients after recurrence. The nomogram prognostic model of OS established by independent prognostic factors had good discrimination,with a C-index of 0.779 (95%CI:0.727-0.831,P < 0.001). Conclusion HR receptor status,whether trastuzumab was the first-line drug,duration of anti-HER2 treatment,and liver metastasis were independent prognostic factors affecting OS in the patients after recurrence. The nomogram prognostic model established in this study can predict the prognosis of patients with HER2-positive advanced breast cancer treated with trastuzumab,guiding individualized treatment.
Key words: trastuzumab, HER2-positive breast cancer, prognosis, nomogram model
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