Establishment of risk prediction nomogram for ipsilateral axillary lymph node metastasis in T1 breast cancer / 浙江大学学报·医学版

:To establish and verify a risk prediction nomogram for ipsilateral axillary lymph node metastasis in breast cancer stage T1 （mass ≤ 2 cm）. :The clinicopathological data of 907 patients with T1 breast cancer who underwent surgical treatment from January 2010 to June 2015 were collected，including 573 cases from the Second Affiliated Hospital of Zhejiang University School of Medicine （modeling group） and 334 cases from Zhejiang University Lishui Hospital （verification group）. The risk factors of ipsilateral axillary lymph node metastasis were analyzed by univariate and multivariate logistic regression. The influencing factors were used to establish a nomogram for predicting ipsilateral axillary lymph nodes metastasis in T1 breast cancer. The model calibration，predictive ability and clinical benefit in the modeling group and the verification group were analyzed by C index，receiver operating characteristic curve，calibration curve and decision curve analysis （DCA） curve，respectively. :Univariate analysis showed that lymph node metastasis was related with primary tumor size，vascular tumor thrombus，Ki-67，histopathological grade，and molecular type （ vascular tumor thrombus，Ki-67 positive，estrogen receptor （ER） positive，and histopathological grade 2-3 were independent risk factors of axillary lymph node metastasis （<0.05 or <0.01）. Based on the independent risk factors，a nomogram prediction model was established. The C indexes of the model group and the validation group were 0.739 （95%:0.693-0.785） and 0.736 （95%:0.678-0.793），respectively. The calibration curve and DCA curve of the modeling group and the verification group indicated that the model was consistent and had good clinical benefit. :Primary tumor size，histopathological grade，vascular tumor thrombus，Ki-67，and ER status are predictors of ipsilateral axillary lymph node metastasis in T1 breast cancer. The established prediction nomogram can effectively predict the risk of ipsilateral axillary lymph node metastasis in T1 breast cancer，which can be used as a reference for individualized axillary management.

Impact on the quality of surgical breast cancer patients at different stages of life / 中国现代医生

Objective To study different surgical methods for breast cancer patients under the influence of the quality of life at different stages. Methods The clinical data of finishing our hospital 160 cases of breast cancer patients , ac-cording to the patient's surgical approach , divided into breast-conserving resection of breast conserving surgery group , mastectomy breast reconstruction group, modified radical group, using the method of returning scale investigation, the statistical quality of life of patients at different stages. Results The patients in the perioperative period, physical, psy-chological and other breast-conserving surgery group and mastectomy breast reconstruction group than modified radical group ( P<0 . 05 ) , with significant difference , but there were no significant difference in the quality of life between the two groups (P>0.05); after 2 years and 5 years, breast-conserving surgery and mastectomy breast reconstruction group's quality of life was higher than that in the modified radical group (P<0.05), with significant difference between the two groups. The patient's physiological , psychological and other aspects of the situation was not statistically signif-icant (P>0.05);perioperative period, after 2 years, a period of 5 years, breast-conserving surgery group and mastecto-my breast reconstruction patients physical, psychological status, quality of life was not statistically significance (P>0.05). Conclusion Breast cancer treatment involves the patient's physical structure , resulting in a greater impact on quality of life and psychological state of the patient's will to a large extent, in the optional cases, give priority to breast-con-serving surgery or mastectomy breast reconstruction may be to some extent , improve the quality of life of patients.