Sentinel lenf nodu metastazı tespit edilen meme kanserli olguların aksiller diseksiyon sorgulamasında nomogramın değeri
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Date
2008
Authors
Güneytepe, Ümit İlker
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Meme kanseri olup sentinel lenf nodu (SLN) metastazı tespit edilen hastalar için, aksiller lenf nodu diseksiyonu (ALND) standart bir tedavi yöntemi olmasına rağmen, vakaların % 40 - 60’ ında sentinel dışı lenf nodu (nSLN) metastazı saptanmamaktadır. Bu çalışmanın amacı aksillada SLN dışı metastaz riskini, dolayısı ile ALND’ a ihtiyaç olup olmadığını sorgulayan Memorial Sloan - Kettering Cancer Center (MSKCC) nomogramının geçerliliğini göstermektir. Aralık 2004 – Mayıs 2008 tarihleri arasında meme kanseri tanısı ile SLN biyopsisi uygulanan, SLN’ si pozitif olup, ALND yapılan 53 hasta çalışmaya dahil edildi. Hastaların nSLN metastaz riskinin hesaplanması için MSKCC tarafından geliştirilen 8 değişkenin yer aldığı online nomogram kullanıldı. Nomogramın geçerliliğini gösterebilmek için nSLN metastaz riski Receiver Operating Characteristics Curve (ROC) eğrisine ve lojistik regresyon analizine tabii tutuldu. ROC eğrisi altında kalan alan (AUC) 0.79 (p< 0.001) olarak tespit edildi. AUC değeri 0.7 – 0.8 arasında kabul edilebilir bir ayırım sağlarken, 0.8’ in üzerindeki değerler iyi bir ayırım sağlar. Çalışmadaki gerçek nSLN pozitiflik olasılığı ile nomogramda öngörülen nSLN pozitifliği olasılığı lojistik regresyon analizi ile karşılaştırıldığında nomogramın nSLN pozitifliğine etki eden bağımsız bir risk faktörü olduğu belirlenmiştir [odds ratio (OR): 1.118, (p = 0.004)]. Nomogramda öngörülen risk yüzdelerine göre hastalar 10 gruba bölündüğünde, her bir risk grubu için öngörülen nSLN metastaz olasılığı, gözlemlenen nSLN metastazı olasılığı ile korelasyon gösterdi [r: 0.754, (p< 0.001)]. Bu çalışma MSKCC meme kanseri nomogramının geçerliliğini desteklemektedir. Nomogram bireylerin nSLN metastaz riskini tahmin etmede ve ALND uygulamasına karar vermede hastalara ve doktorlara anlamlı bir öngörü sunmaktadır.
Although axillary lymph node dissection (ALND) is the standart method of therapy for breast cancer patients with sentinel lymph node (SLN) metastases, non sentinel lymph node (nSLN) metastases can not be detacted in 40% to 60% of cases. The aim of this study is to show nSLN metastasis risk in axilla and hence, to show the validity of Memorial Sloan – Kettering Cancer Center (MSKCC) nomogram, which questions whether ALND is necessary. 53 patients in whom SLN biopsy was performed with the diagnosis of breast cancer and in whom ALND was performed as their SLN was positive were included in our study between December 2004 and May 2008. On-line nomogram with 8 variables developed by MSKCC was used in order to calculate the risk of nSLN metastasis of patients. Receiver Operating Characteristics Curve (ROC) and logistic regression analysis was performed on nSLN metastasis risk to validate the accuracy of the nomogram. The area under the ROC curve (AUC) was determined to be 0.79 (p< 0.001). AUC values of 0.7 to 0.8 represent reasonable discrimination whereas AUC values exceeding 0.8 represent good discrimination. When the nomogram predicted probability and the actual probability of nSLN involvement in the study was compared using logistic regression analysis, it was determined that nomogram was an independent risk factor affecting nSLN positiveness. When the patients were divided into 10 groups by nomogram predicted percentage risk, predicted probability and observed probability of nSLN metastases for each risk group was correlated [r: 0.754, (p< 0.001)]. This study supports the validity of MSKCC breast cancer nomogram. Nomogram provides significant prediction for doctors and patients in estimating an individual’ s risk of nSLN metastasis and in decision making regarding ALND.
Although axillary lymph node dissection (ALND) is the standart method of therapy for breast cancer patients with sentinel lymph node (SLN) metastases, non sentinel lymph node (nSLN) metastases can not be detacted in 40% to 60% of cases. The aim of this study is to show nSLN metastasis risk in axilla and hence, to show the validity of Memorial Sloan – Kettering Cancer Center (MSKCC) nomogram, which questions whether ALND is necessary. 53 patients in whom SLN biopsy was performed with the diagnosis of breast cancer and in whom ALND was performed as their SLN was positive were included in our study between December 2004 and May 2008. On-line nomogram with 8 variables developed by MSKCC was used in order to calculate the risk of nSLN metastasis of patients. Receiver Operating Characteristics Curve (ROC) and logistic regression analysis was performed on nSLN metastasis risk to validate the accuracy of the nomogram. The area under the ROC curve (AUC) was determined to be 0.79 (p< 0.001). AUC values of 0.7 to 0.8 represent reasonable discrimination whereas AUC values exceeding 0.8 represent good discrimination. When the nomogram predicted probability and the actual probability of nSLN involvement in the study was compared using logistic regression analysis, it was determined that nomogram was an independent risk factor affecting nSLN positiveness. When the patients were divided into 10 groups by nomogram predicted percentage risk, predicted probability and observed probability of nSLN metastases for each risk group was correlated [r: 0.754, (p< 0.001)]. This study supports the validity of MSKCC breast cancer nomogram. Nomogram provides significant prediction for doctors and patients in estimating an individual’ s risk of nSLN metastasis and in decision making regarding ALND.
Description
Keywords
Sentinel nod, Nomogram, Meme kanseri, Aksiller lenf nodu diseksiyonu, Sentinel node, Nomogram, Breast cancer, Axillary lymph node dissection
Citation
İlker, Ü. İ. (2008). Sentinel lenf nodu metastazı tespit edilen meme kanserli olguların aksiller diseksiyon sorgulamasında nomogramın değeri. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.