CONUT 评分对 HER2 阳性早期乳腺癌复发转移的预测作用

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摘要目的探讨控制营养状态(CONUT)评分对人表皮生长因子受体 2(HER2)阳性早期乳腺癌患者复发转移中的预测价值。方法将 2012 年 1 月至 2020 年 10 月于新疆医科大学附属肿瘤医院行手术切除并接受曲妥珠单抗治疗的 154 例 HER2 阳性早期乳腺癌患者为研究对象进行回顾性分析。基于患者术前血清白蛋白、总胆固醇水平及外周血淋巴细胞计数,计算 CONUT 评分。通过受试者操作特征曲线(ROC 曲线)对 CONUT 评分截止点进行分类:高 CONUT 与低 CONUT 组。组间基线特征分布的比较采用卡方 χ 2 检验或 Fisher 确切概率法。绘制 Kaplan-Meier 曲线,并通过单因素和多因素 Cox 回归分析确定 CONUT 评分与乳腺癌患者复发转移的关系。结果 ROC 曲线表明 CONUT 评分预测乳腺癌患者术后复发转移的最佳截止点为 2. 5,曲线下面积(AUC)为 0. 689 (95%CI = 0. 577~ 0. 801)。基于此截止点,将所有患者分为高 CONUT 组(≥3 分)与低 CONUT 组(<3 分)。 Kaplan-Meier 曲线展示两组患者的 5 年无复发生存(RFS)率分别为 69. 7%和 86. 9%,差异具有统计学意义 (χ 2 = 8. 001, P= 0. 005)。亚组分析表明,无论 TNM 分期 I 期(5 年 RFS 率:80. 9%比 96. 9%, χ 2 = 7. 946, P= 0. 005)还是Ⅱ期 (5 年 RFS:45. 6%比 68. 2%, χ 2 = 4. 589, P= 0. 048),高 CONUT 组均与乳腺癌复发转移相关,提示患者预后不佳。单、多因素 Cox 回归分析的结果证实,肿瘤大小(HR= 2. 184, 95%CI = 1. 062~ 4. 492,P= 0. 034)、淋巴结转移(HR = 2. 739, 95%CI = 1. 283 ~ 5. 847,P= 0. 009)与 CONUT 评分(HR= 2. 513, 95%CI = 1. 196~ 5. 280,P = 0. 015)是 HER2 阳性早期乳腺癌患者复发转移的独立风险因素。结论 CONUT 评分或许可作为一项预测 HER2 阳性早期乳腺癌复发转移的有效工具,为肿瘤监测及个性化治疗提供指导。

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关键词 ：关键词: 乳腺癌, 控制营养状态, 复发, 转移, 预后

Abstract：Objective To investigate the predictive value of controlling nutritional status CONUT as a marker of recurrence and metastasis in HER2-positive early breast cancer patients. Method A total of 154 HER2-positive early breast cancer patients who underwent surgical resection and trastuzumab treatment in Affiliated Tumor Hospital of Xinjiang Medical University from January 2012 to October 2020 were retrospectively analyzed. CONUT score was calculated according to the lymphocyte count in peripheral blood serum albumin and total cholesterol level. The cut-off value of CONUT score was identified by the receiver operation characteristics curve ROC curve and all patients were divided into high CONUT and low CONUT group based on the cut-off point. The comparison of baseline characteristics between the two groups was performed using Chi square χ 2 test or Fisher exact test. The Kaplan-Meier curves were plotted and the correlation between CONUT score and recurrence-free survival RFS of breast cancer patients was determined by the univariate and multivariate Cox regression analysis. Result The ROC curve showed that the best cut-off value of CONUT score for predicting recurrence and metastasis of breast cancer patients was 2. 5 with an AUC value of 0. 689 95% CI 0. 577-0. 801 . All patients were divided into high CONUT ≥3 points and low CONUT <3 points group according to this cut-off value. Kaplan-Meier survival curves showed that the 5-year RFS of the two patient groups were 69. 7% and 86. 9% with a significantly statistical significance χ 2 = 8. 001 P= 0. 005 . Subgroup analysis further demonstrated that CONUT ≥3 were significantly associated with recurrence and metastasis of breast cancer patients irrespective of TNM stage stage I 5-year RFS 80. 9% vs 96. 9% χ 2 = 7. 946 P= 0. 005 stage Ⅱ 5-year RFS 45. 6% vs 68. 2% χ 2 = 4. 589 P = 0. 048 . The results of univariate and multivariate Cox analysis indicated that tumor size HR= 2. 184 95%CI = 1. 062-4. 492 P= 0. 034 lymph node metastasis HR = 2. 739 95%CI = 1. 283-5. 847 P = 0. 009 as well as CONUT score HR = 2. 513 95%CI = 1. 196-5. 280 P = 0. 015 were independent risk factors for recurrence and 肿瘤代谢与营养电子杂志 2022 年 6 月 9 日第 9 卷第 3 期 Electron J Metab Nutr Cancer, Jun. 9, 2022, Vol. 9, No. 3 ·333· metastasis in HER2-positive early breast cancer patients. Conclusion CONUT might be a predictor of recurrence and metastasis in HER2-positive early breast cancer patients and it might provide important clinical guidance for cancer surveillance and individualized treatment.

收稿日期: 2022-01-03

基金资助:新疆自治区自然科学基金(2017D01C379)

引用本文:

伊丽娜,雪来提·派祖拉,张晨光,许文婷. CONUT 评分对 HER2 阳性早期乳腺癌复发转移的预测作用[J]. 肿瘤代谢与营养电子杂志, 2022, 9(3): 333-339.
Irina, Xue Laiti, Paizula, Zhang Chenguang,Xu Wenting. Predictive value of control nutritional status for recurrence and metastasis in HER2-positive early breast cancer patients. Electron J Metab Nutr Cancer, 2022, 9(3): 333-339.