Analysis of risk factors related to distant metastasis in patients with early breast cancer undergoing endoscopic nipple-areola-sparing subcutaneous gland resection / 国际外科学杂志

ABSTRACT

Objective:To analyze the risk factors related to distant metastasis in patients with early breast cancer who undergoing endoscopic nipple-areola-sparing subcutaneous gland resection.Methods:A retrospective analysis was used to select 402 patients with early breast cancer from January 2012 to January 2016. According to the breast cancer metastasis within 5 years after surgery, the patients were divided into the metastasis group ( n=37) and the control group ( n=365). Metastasis group refers to patients with breast cancer metastasis within 5 years after surgery, and control group refers to patients without breast cancer metastasis within 5 years after surgery. The age, family history of breast cancer, breast cancer stage, location of lesion, number of lesions, diameter of tumor, histopathological type, histological grade, molecular classification, lymph node metastasis, distant metastasis site, number of distant metastasis, operation time, intraoperative blood loss, axillary operation, carcinoembryonic antigen (CEA), cancer antigen 125 (CA125), cancer antigen 153 (CA153), cancer antigen 199 (CA199), postoperative extubation time, drainage amount, postoperative subcutaneous effusion, flap necrosis, incision infection, poor incision healing, dyskinesia of affected limbs, length of hospital stay were compared between the two groups. Measurement data were expressed as mean ± standard deviation ( ± s), and t-test was used for comparison between groups; Chi-square test was used for comparison of enumeration data between groups. Multivariate logistic regression analysis was used to analyze the independent risk factors of distant metastasis undergoing endoscopic nipple-areola-sparing subcutaneous gland resection in patients with early breast cancer. Using SPSS decision tree model to predict the intensity and hierarchical nodes of each risk factor. Receiver operating characteristic curve (ROC) were drawn using R 4.0.2 software, and the area under the ROC curve (AUC) was used to validate stratified nodes for continuous variables. Results:Multivariate Logisitic regression analysis showed that age < 40 years ( OR=2.715, 95% CI 2.349-3.168, P=0.002), lymph node metastasis ( OR=2.604, 95% CI 2.413-2.825, P=0.009), histological grade G3 ( OR=2.473, 95% CI 2.331-2.701, P=0.007), CEA ≥ 4.10 ng/mL ( OR=2.481, 95% CI 2.357-2.616, P=0.003) and CA153 ≥ 18.90 U/mL ( OR=2.467, 95% CI 2.344-2.620, P=0.002) were independent risk factors for distant metastasis after endoscopic nipple-areola-sparing subcutaneous gland resection in patients with early breast cancer. The decision tree model showed that age < 40 years ( χ2=16.18, P<0.001), lymph node metastasis ( χ2=9.53, P=0.002), histological grade G3 ( χ2=11.73, P<0.001), CEA ≥ 4.10 ng/mL ( χ2=13.62, P=0.001) and CA153 ≥ 18.90 U/mL ( χ2=7.39, P=0.010) could predict distant metastasis after endoscopic nipple-areola-sparing subcutaneous gland resection in patients with early breast cancer.The AUC values of ROC curves of each node were 0.814, 0.789, 0.761, 0.696 and 0.745 respectively, the sensitivity were 84.35%, 74.96%, 79.35%, 71.59% and 73.10% respectively, and the specificity were 80.16%, 77.55%, 76.54%, 70.32% and 76.83%, respectively. The prediction performance of the model was good. Conclusion:Age < 40 years, lymph node metastasis, histological grade G3, CEA ≥ 4.10 ng/mL and CA153 ≥ 18.90 U/mL are independent risk factors for distant metastasis after endoscopic nipple-areola-sparing subcutaneous gland resection in early breast cancer patients.