1.Progress in cancer therapy-related oral mucositis pathogenesis,diagnosis,and treatment
Chinese Journal of Clinical Oncology 2025;52(5):248-252
Oral mucositis(OM)is a prevalent and debilitating cancer therapy-related side effect that significantly impairs the quality of life of patients with cancer.In this article,we review anticancer treatment-induced OM,elucidate the underlying pathophysiological mechanisms,and discuss various preventive and therapeutic strategies,including basic oral care,nutritional supplements,cryotherapy,photobiomodula-tion therapy,and pharmacological interventions.While single modality treatments might yield certain clinical benefits,an integrated ap-proach,combining prophylactic measures with multimodal therapies,could more effectively reduce OM incidence and severity,promote mucosal healing,minimize the risk of serious complications,and enhance patient outcomes.
2.Analysis of the Distribution of Characteristics and Combination Rules of Syndrome Elements in Recurrent Oral Ulcers Based on Literature Review
Tianxiao FU ; Wenwen LU ; Fenglin HU
Journal of Zhejiang Chinese Medical University 2025;49(3):326-332
[Objective]To summarize the distribution characteristics and mutual combination rules of syndrome elements through the extraction of syndrome elements from recent literature on recurrent oral ulcers,analyze the etiology and pathogenesis and provide theoretical basis for clinical diagnosis and treatment in traditional Chinese medicine.[Methods]The clinical literature related to recurrent oral ulcers in the past four years in the China National Knowledge Infrastructure and WanFang databases was searched,key information such as syndromes and syndrome elements was extracted,an information database was established,and frequency analysis was conducted.[Results]One hundred and sixty-one literatures were included,and 26 standard Chinese medicine syndromes for recurrent oral ulcers were extracted.Heart-spleen heat accumulation syndrome was the most common,followed by Yin deficiency and fire hyperactivity syndrome,dampness-heat due to spleen deficiency syndrome,phlegm and blood stasis were the least common.A total of 8 disease location syndrome elements were extracted from the spleen,heart,stomach,liver,kidney,gallbladder,lung and large intestine.The most common disease location syndrome was the spleen,followed by the heart,and the large intestine was the least frequent.Fourteen disease syndrome elements including heat,blood deficiency,and poison were extracted.The most common was heat,followed by Yin deficiency,and dryness was the least frequent.There were 10 combinations of syndrome elements,among which spleen+heat,heart+spleen+heat,heart+fire were the most frequent,and liver+blood deficiency was the least frequent.[Conclusion]The main type of recurrent oral ulcers is characterized by heart-spleen heat accumulation,which is most closely related to the spleen,the pathological factor is heat.Clinical treatment of recurrent oral ulcers often starts with the three organs of the spleen,heart and stomach,with the three most important methods of reducing fire,clearing heat and eliminating dampness.
3.Construction of a nomogram model for malignancy risk of breast lesions based on quantitative multimodal ultrasound features and clinical indicators
Quan CHEN ; Yan ZHENG ; Yang GU ; Ping HU ; Qing JIN ; Fenglin DONG
Chinese Journal of Ultrasonography 2025;34(4):303-310
Objective:To construct a nomogram prediction model for the malignant risk of breast lesions based on quantitative multimodal ultrasound features and clinical indicators,and to explore its clinical application value.Methods:A total of 430 patients with breast diseases(473 lesions)confirmed by pathological examination at Kunshan Traditional Chinese Medicine Hospital from August 2018 to December 2023 were retrospectively analyzed in the study. All the patients underwent routine handheld ultrasound(HHUS),automated breast volume scanning(ABVS)and ultrasound elastography(UE)examinations before biopsy or surgery. Four hundred and seventy-three breast lesions were randomly divided into training set( n=331)and validation set( n=142)at a ratio of 7∶3. The ABVS ultrasound features of 331 lesions in the training set were analyzed to identify the risk features of malignant breast lesions. Based on the weight of the regression coefficients β,the ABVS risk features were assigned quantitative scores for each lesion. Using pathology results as the gold standard,ROC curves were plotted to compare the diagnostic efficacy of ABVS quantitative scoring and HHUS in the training set. The variable with higher efficacy was selected for inclusion in the multivariable logistic regression analysis. Based on the identified independent predictive factors,a nomogram was constructed to quantify the malignancy risk of breast lesions. The nomogram was evaluated and validated using the area under the ROC curve(AUC),calibration curve and clinical decision curve analysis(DCA). Results:The AUC for ABVS quantitative scoring and HHUS in distinguishing benign and malignant breast lesions were 0.941 and 0.903,respectively,with a statistically significant difference( Z=2.081, P=0.037). Multivariate Logistic regression analysis showed that age,ABVS quantitative score and elasticity score were independent predictors for the identification of benign and malignant breast lesions(all P<0.05). A nomogram was constructed based on the aforementioned independent predictive factors. The AUC for the nomogram were 0.968 in the training set and 0.943 in the validation set,indicating good discrimination. The calibration curve indicated that the predicted probabilities from the nomogram were in good agreement with the actual outcomes. DCA indicated strong clinical applicability of the nomogram. Conclusions:The nomogram based on ABVS quantitative scores,elasticity scores,and age demonstrates high diagnostic value,providing a novel method for preoperative assessment of the malignancy risk of breast lesions.
4.Prognostic analysis and application value of adjuvant chemotherapy after radical resection for stage Ⅰ gastric cancer
Jie CHEN ; Xiaogang QU ; Keshu HU ; Mingde ZANG ; Hongda PAN ; Jun LU ; Xiaowen LIU ; Yanong WANG ; Fenglin LIU
Chinese Journal of Digestive Surgery 2025;24(8):1033-1043
Objective:To explore the prognosis after radical resection for stage Ⅰ gastric cancer and the application value of adjuvant chemotherapy.Methods:The retrospective cohort study was conducted. The clinicopathological data of 3 353 patients with stage Ⅰ gastric cancer who were admitted to Fudan University Shanghai Cancer Center from January 2000 to December 2022 were collected. There were 2 369 males and 984 females, aged 60(range, 21-91) years. All patients underwent radical R 0 resection. Observation indicators: (1) clinicopathological characteristics of patients; (2) influencing factors for postoperative prognosis of patients; (3) prognostic analysis of patients; (4) construction and validation of a predictive model for the efficacy of postoperative adjuvant chemotherapy. Comparison of count data between groups was conducted using the chi-square test. Univariate and multivariate analyses were performed using the Cox proportional hazards regression model. The Kaplan-Meier method was used to calculate survival rates and draw survival curves, and the Log-rank test was used for survival analysis. Based on the multivariate analysis result, a nomogram prediction model was constructed to predict survival benefit. Results:(1) Clinicopatho-logical characteristics of patients. The highly, moderately, and poorly differentiated tumors were observed in 16, 234, 396 cases of 646 patients aged <50 years and 279, 1 617, 811 cases of 2 707 pati-ents aged ≥50 years, respectively, showing a significant difference in degree of tumor differentiation between them ( P<0.05). For 297 patients in stage T1N1M0, cases aged <50 years and ≥50 years were 71 and 226, cases of males and females were 184 and 113, cases with negative and positive vascular invasion were 37 and 260, cases with negative and positive nerve invasion were 275 and 22, cases without and with postoperative adjuvant chemotherapy were 222 and 75, respectively. The above indicators for 678 patients in stage T2N0M0 105, 573, 533, 145, 517, 161, 526, 152, 563, 115, respectively. There were significant differences in the above indicators between the two groups ( P<0.05). (2) Influencing factors for postoperative prognosis of patients. Results of multivariate analysis showed that age ≥50 years, stage T2, moderately differentiated tumor, the number of lymph nodes dissected <16, positive vascular invasion, carcinoembryonic antigen (CEA) ≥5 μg/L, and CA19-9 ≥37 U/mL were independent risk factors for disease-free survival (DFS) after surgery for stage Ⅰ gastric cancer ( hazard ratio=4.600, 1.555, 1.835, 1.362, 1.451, 1.571, 2.134, 95% confidence interval as 2.806-7.541, 1.205-2.006, 1.016-3.314, 1.059-1.753, 1.057-1.993, 1.100-2.243, 1.257-3.625, P<0.05). Age ≥50 years, stage T2, the number of lymph nodes dissected <16, positive vascular invasion, CEA ≥5 μg/L, and CA19-9 ≥37 U/mL were independent risk factors for overall survival (OS) after surgery for stage Ⅰ gastric cancer ( hazard ratio=5.208, 1.597, 1.373, 1.520, 1.464, 2.356, 95% confidence interval as 3.028-8.955, 1.231-2.072, 1.060-1.777, 1.099-2.104, 1.004-2.134, 1.385-4.009, P<0.05). Postoperative adjuvant chemotherapy was an independent protective factor for both DFS and OS after surgery for stage I gastric cancer ( hazard ratio=0.361 0.297, 95% confidence interval as 0.177-0.736, 0.131-0.674, P<0.05). (3) Prognostic analysis of patients. According to the results of multi-variate analysis, among 3 353 patients, there were significant differences in 5-year DFS rate and 10-year OS rate between patients aged <50 years and ≥50 years ( P<0.05). There were significant differences in 5-year DFS rate and 10-year OS rate among patients in TNM stage ⅠA and ⅠB ( P<0.05). There were significant differences in 5-year DFS rate and 10-year OS rate among patients in stage T1N0M0, T1N1M0, T2N0M0 ( P<0.05). There were significant differences in 5-year DFS rate and 10-year OS rate among patients with the highly, moderately, and poorly differentiated tumors ( P<0.05). There were significant differences in 5-year DFS rate and 10-year OS rate among patients with the number of lymph lodes dissected <16 and ≥16 ( P<0.05). There were significant differences in 5-year DFS rate and 10-year OS rate between patients with negative and positive vascular invasion ( P<0.05). There were significant differences in 5-year DFS rate and 10-year OS rate between patients with and without postoperative adjuvant chemotherapy ( P<0.05), among patients in stage T1N0M0, T1N1M0, T2N0M0 who received no postoperative adjuvant chemotherapy ( P<0.05). For patients in stage T1N1M0, there was no significant difference in 5-year DFS rate and 10-year OS rate between patients with and without postoperative adjuvant chemotherapy ( P>0.05).Results of stratified analysis showed that for patients aged ≥ 50 years, there were significant differences in 5-year DFS rate and 10-year OS rate between patients with and without postoperative adjuvant chemotherapy ( P<0.05). For patients in stage T2N0M0, there were significant differences in 5-year DFS rate and 10-year OS rate between patients with and without postoperative adjuvant chemotherapy ( P<0.05). For patients with positive vascular invasion, there were significant differences in 5-year DFS rate and 10-year OS rate between patients with and without postoperative adjuvant chemotherapy ( P<0.05). (4) Construction and validation of a predictive model for the efficacy of adjuvant chemotherapy. A nomogram predictive model was constructed based on the multivariate analysis results of OS and used for calculating net benefits and distribution. Among the 3 096 patients without postoperative adjuvant chemotherapy, 1 009 cases had a predicted net benefit of >5%-10%, and 250 patients had a predicted net benefit >10%. The predicted survival analysis further verified that the predicted benefit of adjuvant chemotherapy was consistent with the prognosis of patients. Conclusions:Patients with age ≥50 years, stage T2 tumors, moderately differentiated tumor, the number of lymph nodes dissected <16, positive vascular invasion have worse survival prognosis postoperative. Postoperative adjuvant chemotherapy provides better prognosis in high-risk patients. Patients in stage T1N1M0 have lower recurrence and survival risks, of whom with 1 metastatic lymph node is more suitable for follow-up rather than postoperative adjuvant chemotherapy.
5.Minimum negative lymph node dissection during radical gastrectomy for gastric cancer: a 22-year, single-center retrospective study
Jie CHEN ; Jun LU ; Yingxue LIU ; Keshu HU ; Hongda PAN ; Mingde ZANG ; Ziwen LONG ; Bin KE ; Fenglin LIU
Chinese Journal of Gastrointestinal Surgery 2025;28(9):1034-1043
Objective:To establish the minimum number of negative lymph nodes (nLN) required for patients undergoing gastrectomy.Methods:This was a retrospective cohort study with inclusion criteria as follows: (1) radical gastrectomy; (2) histologically confirmed adenocarcinoma; (3) complete tumor staging information; and (4) known number of lymph nodes harvested. The exclusion criteria were: (1) other concurrent malignant tumors; (2) metastatic or recurrent gastric cancer; (3) initial surgery performed at another hospital; (4) preoperative neoadjuvant therapy; (5) distant metastasis; and (6) incomplete clinical data or follow-up information. Based on the above criteria, a total of 11 167 patients with gastric adenocarcinoma who underwent radical subtotal gastrectomy (RSG) or radical total gastrectomy (RTG) in the Department of Gastric Surgery, Fudan University Shanghai Cancer Center between January 1, 2000, and December 31, 2022, were included in the study. Among them, there were 7 596 cases in the RSG group and 3 571 cases in the RTG group. Restricted cubic spline (RCS) analysis was used to determine the ideal threshold for nLN for RSG and RTG patients. Survival analysis was conducted using Kaplan-Meier (KM) curves and log-rank tests, and propensity score matching (PSM) was utilized to balance parameters between two groups. Furthermore, subgroup analysis was conducted for RSG patients based on tumor location (upper, middle and lower) to determine the minimum number of nLN in each subgroup.Results:For patients who underwent RSG, the mean number of nLN was 21.9, with a median of 21. RCS analysis showed that more than 21 nLN was associated with better survival. Moreover, both pre- and post-PSM analysis confirmed that patients with nLN ≥21 had better survival benefits compared to those with nLN <21 (overall survival [OS]: P<0.001 before PSM, P=0.013 after PSM; disease-free survival [DFS]: P<0.001 before PSM, P=0.013 after PSM). For patients who underwent RTG, the mean number of nLN was 23.5, with a median of 22. Here RCS analysis indicated that more than 22 nLN was associated with better postoperative survival in RTG patients, and both pre- and post-PSM analysis confirmed that patients with nLN ≥22 had better survival benefits compared to those with nLN<22 (OS: P<0.001 both before and after PSM; DFS: P<0.001 both before and after PSM). Subgroup analysis showed that for RSG patients with tumor located in the upper part, having ≥17 nLN (OS: both P<0.001), and for RSG patients with tumor located in the middle and lower part, having ≥22 nLN (OS: both P<0.001), were associated with better prognoses. Conclusions:For patients who receive RSG, the minimal number of nLN is ideally ≥21 (upper ≥17, middle and lower ≥22). Similarly, for patients who receive RTG, the minimum number of nLN ideally is 22.
6.Prognostic analysis and application value of adjuvant chemotherapy after radical resection for stage Ⅰ gastric cancer
Jie CHEN ; Xiaogang QU ; Keshu HU ; Mingde ZANG ; Hongda PAN ; Jun LU ; Xiaowen LIU ; Yanong WANG ; Fenglin LIU
Chinese Journal of Digestive Surgery 2025;24(8):1033-1043
Objective:To explore the prognosis after radical resection for stage Ⅰ gastric cancer and the application value of adjuvant chemotherapy.Methods:The retrospective cohort study was conducted. The clinicopathological data of 3 353 patients with stage Ⅰ gastric cancer who were admitted to Fudan University Shanghai Cancer Center from January 2000 to December 2022 were collected. There were 2 369 males and 984 females, aged 60(range, 21-91) years. All patients underwent radical R 0 resection. Observation indicators: (1) clinicopathological characteristics of patients; (2) influencing factors for postoperative prognosis of patients; (3) prognostic analysis of patients; (4) construction and validation of a predictive model for the efficacy of postoperative adjuvant chemotherapy. Comparison of count data between groups was conducted using the chi-square test. Univariate and multivariate analyses were performed using the Cox proportional hazards regression model. The Kaplan-Meier method was used to calculate survival rates and draw survival curves, and the Log-rank test was used for survival analysis. Based on the multivariate analysis result, a nomogram prediction model was constructed to predict survival benefit. Results:(1) Clinicopatho-logical characteristics of patients. The highly, moderately, and poorly differentiated tumors were observed in 16, 234, 396 cases of 646 patients aged <50 years and 279, 1 617, 811 cases of 2 707 pati-ents aged ≥50 years, respectively, showing a significant difference in degree of tumor differentiation between them ( P<0.05). For 297 patients in stage T1N1M0, cases aged <50 years and ≥50 years were 71 and 226, cases of males and females were 184 and 113, cases with negative and positive vascular invasion were 37 and 260, cases with negative and positive nerve invasion were 275 and 22, cases without and with postoperative adjuvant chemotherapy were 222 and 75, respectively. The above indicators for 678 patients in stage T2N0M0 105, 573, 533, 145, 517, 161, 526, 152, 563, 115, respectively. There were significant differences in the above indicators between the two groups ( P<0.05). (2) Influencing factors for postoperative prognosis of patients. Results of multivariate analysis showed that age ≥50 years, stage T2, moderately differentiated tumor, the number of lymph nodes dissected <16, positive vascular invasion, carcinoembryonic antigen (CEA) ≥5 μg/L, and CA19-9 ≥37 U/mL were independent risk factors for disease-free survival (DFS) after surgery for stage Ⅰ gastric cancer ( hazard ratio=4.600, 1.555, 1.835, 1.362, 1.451, 1.571, 2.134, 95% confidence interval as 2.806-7.541, 1.205-2.006, 1.016-3.314, 1.059-1.753, 1.057-1.993, 1.100-2.243, 1.257-3.625, P<0.05). Age ≥50 years, stage T2, the number of lymph nodes dissected <16, positive vascular invasion, CEA ≥5 μg/L, and CA19-9 ≥37 U/mL were independent risk factors for overall survival (OS) after surgery for stage Ⅰ gastric cancer ( hazard ratio=5.208, 1.597, 1.373, 1.520, 1.464, 2.356, 95% confidence interval as 3.028-8.955, 1.231-2.072, 1.060-1.777, 1.099-2.104, 1.004-2.134, 1.385-4.009, P<0.05). Postoperative adjuvant chemotherapy was an independent protective factor for both DFS and OS after surgery for stage I gastric cancer ( hazard ratio=0.361 0.297, 95% confidence interval as 0.177-0.736, 0.131-0.674, P<0.05). (3) Prognostic analysis of patients. According to the results of multi-variate analysis, among 3 353 patients, there were significant differences in 5-year DFS rate and 10-year OS rate between patients aged <50 years and ≥50 years ( P<0.05). There were significant differences in 5-year DFS rate and 10-year OS rate among patients in TNM stage ⅠA and ⅠB ( P<0.05). There were significant differences in 5-year DFS rate and 10-year OS rate among patients in stage T1N0M0, T1N1M0, T2N0M0 ( P<0.05). There were significant differences in 5-year DFS rate and 10-year OS rate among patients with the highly, moderately, and poorly differentiated tumors ( P<0.05). There were significant differences in 5-year DFS rate and 10-year OS rate among patients with the number of lymph lodes dissected <16 and ≥16 ( P<0.05). There were significant differences in 5-year DFS rate and 10-year OS rate between patients with negative and positive vascular invasion ( P<0.05). There were significant differences in 5-year DFS rate and 10-year OS rate between patients with and without postoperative adjuvant chemotherapy ( P<0.05), among patients in stage T1N0M0, T1N1M0, T2N0M0 who received no postoperative adjuvant chemotherapy ( P<0.05). For patients in stage T1N1M0, there was no significant difference in 5-year DFS rate and 10-year OS rate between patients with and without postoperative adjuvant chemotherapy ( P>0.05).Results of stratified analysis showed that for patients aged ≥ 50 years, there were significant differences in 5-year DFS rate and 10-year OS rate between patients with and without postoperative adjuvant chemotherapy ( P<0.05). For patients in stage T2N0M0, there were significant differences in 5-year DFS rate and 10-year OS rate between patients with and without postoperative adjuvant chemotherapy ( P<0.05). For patients with positive vascular invasion, there were significant differences in 5-year DFS rate and 10-year OS rate between patients with and without postoperative adjuvant chemotherapy ( P<0.05). (4) Construction and validation of a predictive model for the efficacy of adjuvant chemotherapy. A nomogram predictive model was constructed based on the multivariate analysis results of OS and used for calculating net benefits and distribution. Among the 3 096 patients without postoperative adjuvant chemotherapy, 1 009 cases had a predicted net benefit of >5%-10%, and 250 patients had a predicted net benefit >10%. The predicted survival analysis further verified that the predicted benefit of adjuvant chemotherapy was consistent with the prognosis of patients. Conclusions:Patients with age ≥50 years, stage T2 tumors, moderately differentiated tumor, the number of lymph nodes dissected <16, positive vascular invasion have worse survival prognosis postoperative. Postoperative adjuvant chemotherapy provides better prognosis in high-risk patients. Patients in stage T1N1M0 have lower recurrence and survival risks, of whom with 1 metastatic lymph node is more suitable for follow-up rather than postoperative adjuvant chemotherapy.
7.Progress in cancer therapy-related oral mucositis pathogenesis,diagnosis,and treatment
Chinese Journal of Clinical Oncology 2025;52(5):248-252
Oral mucositis(OM)is a prevalent and debilitating cancer therapy-related side effect that significantly impairs the quality of life of patients with cancer.In this article,we review anticancer treatment-induced OM,elucidate the underlying pathophysiological mechanisms,and discuss various preventive and therapeutic strategies,including basic oral care,nutritional supplements,cryotherapy,photobiomodula-tion therapy,and pharmacological interventions.While single modality treatments might yield certain clinical benefits,an integrated ap-proach,combining prophylactic measures with multimodal therapies,could more effectively reduce OM incidence and severity,promote mucosal healing,minimize the risk of serious complications,and enhance patient outcomes.
8.Analysis of the Distribution of Characteristics and Combination Rules of Syndrome Elements in Recurrent Oral Ulcers Based on Literature Review
Tianxiao FU ; Wenwen LU ; Fenglin HU
Journal of Zhejiang Chinese Medical University 2025;49(3):326-332
[Objective]To summarize the distribution characteristics and mutual combination rules of syndrome elements through the extraction of syndrome elements from recent literature on recurrent oral ulcers,analyze the etiology and pathogenesis and provide theoretical basis for clinical diagnosis and treatment in traditional Chinese medicine.[Methods]The clinical literature related to recurrent oral ulcers in the past four years in the China National Knowledge Infrastructure and WanFang databases was searched,key information such as syndromes and syndrome elements was extracted,an information database was established,and frequency analysis was conducted.[Results]One hundred and sixty-one literatures were included,and 26 standard Chinese medicine syndromes for recurrent oral ulcers were extracted.Heart-spleen heat accumulation syndrome was the most common,followed by Yin deficiency and fire hyperactivity syndrome,dampness-heat due to spleen deficiency syndrome,phlegm and blood stasis were the least common.A total of 8 disease location syndrome elements were extracted from the spleen,heart,stomach,liver,kidney,gallbladder,lung and large intestine.The most common disease location syndrome was the spleen,followed by the heart,and the large intestine was the least frequent.Fourteen disease syndrome elements including heat,blood deficiency,and poison were extracted.The most common was heat,followed by Yin deficiency,and dryness was the least frequent.There were 10 combinations of syndrome elements,among which spleen+heat,heart+spleen+heat,heart+fire were the most frequent,and liver+blood deficiency was the least frequent.[Conclusion]The main type of recurrent oral ulcers is characterized by heart-spleen heat accumulation,which is most closely related to the spleen,the pathological factor is heat.Clinical treatment of recurrent oral ulcers often starts with the three organs of the spleen,heart and stomach,with the three most important methods of reducing fire,clearing heat and eliminating dampness.
9.Minimum negative lymph node dissection during radical gastrectomy for gastric cancer: a 22-year, single-center retrospective study
Jie CHEN ; Jun LU ; Yingxue LIU ; Keshu HU ; Hongda PAN ; Mingde ZANG ; Ziwen LONG ; Bin KE ; Fenglin LIU
Chinese Journal of Gastrointestinal Surgery 2025;28(9):1034-1043
Objective:To establish the minimum number of negative lymph nodes (nLN) required for patients undergoing gastrectomy.Methods:This was a retrospective cohort study with inclusion criteria as follows: (1) radical gastrectomy; (2) histologically confirmed adenocarcinoma; (3) complete tumor staging information; and (4) known number of lymph nodes harvested. The exclusion criteria were: (1) other concurrent malignant tumors; (2) metastatic or recurrent gastric cancer; (3) initial surgery performed at another hospital; (4) preoperative neoadjuvant therapy; (5) distant metastasis; and (6) incomplete clinical data or follow-up information. Based on the above criteria, a total of 11 167 patients with gastric adenocarcinoma who underwent radical subtotal gastrectomy (RSG) or radical total gastrectomy (RTG) in the Department of Gastric Surgery, Fudan University Shanghai Cancer Center between January 1, 2000, and December 31, 2022, were included in the study. Among them, there were 7 596 cases in the RSG group and 3 571 cases in the RTG group. Restricted cubic spline (RCS) analysis was used to determine the ideal threshold for nLN for RSG and RTG patients. Survival analysis was conducted using Kaplan-Meier (KM) curves and log-rank tests, and propensity score matching (PSM) was utilized to balance parameters between two groups. Furthermore, subgroup analysis was conducted for RSG patients based on tumor location (upper, middle and lower) to determine the minimum number of nLN in each subgroup.Results:For patients who underwent RSG, the mean number of nLN was 21.9, with a median of 21. RCS analysis showed that more than 21 nLN was associated with better survival. Moreover, both pre- and post-PSM analysis confirmed that patients with nLN ≥21 had better survival benefits compared to those with nLN <21 (overall survival [OS]: P<0.001 before PSM, P=0.013 after PSM; disease-free survival [DFS]: P<0.001 before PSM, P=0.013 after PSM). For patients who underwent RTG, the mean number of nLN was 23.5, with a median of 22. Here RCS analysis indicated that more than 22 nLN was associated with better postoperative survival in RTG patients, and both pre- and post-PSM analysis confirmed that patients with nLN ≥22 had better survival benefits compared to those with nLN<22 (OS: P<0.001 both before and after PSM; DFS: P<0.001 both before and after PSM). Subgroup analysis showed that for RSG patients with tumor located in the upper part, having ≥17 nLN (OS: both P<0.001), and for RSG patients with tumor located in the middle and lower part, having ≥22 nLN (OS: both P<0.001), were associated with better prognoses. Conclusions:For patients who receive RSG, the minimal number of nLN is ideally ≥21 (upper ≥17, middle and lower ≥22). Similarly, for patients who receive RTG, the minimum number of nLN ideally is 22.
10.Construction of a nomogram model for malignancy risk of breast lesions based on quantitative multimodal ultrasound features and clinical indicators
Quan CHEN ; Yan ZHENG ; Yang GU ; Ping HU ; Qing JIN ; Fenglin DONG
Chinese Journal of Ultrasonography 2025;34(4):303-310
Objective:To construct a nomogram prediction model for the malignant risk of breast lesions based on quantitative multimodal ultrasound features and clinical indicators,and to explore its clinical application value.Methods:A total of 430 patients with breast diseases(473 lesions)confirmed by pathological examination at Kunshan Traditional Chinese Medicine Hospital from August 2018 to December 2023 were retrospectively analyzed in the study. All the patients underwent routine handheld ultrasound(HHUS),automated breast volume scanning(ABVS)and ultrasound elastography(UE)examinations before biopsy or surgery. Four hundred and seventy-three breast lesions were randomly divided into training set( n=331)and validation set( n=142)at a ratio of 7∶3. The ABVS ultrasound features of 331 lesions in the training set were analyzed to identify the risk features of malignant breast lesions. Based on the weight of the regression coefficients β,the ABVS risk features were assigned quantitative scores for each lesion. Using pathology results as the gold standard,ROC curves were plotted to compare the diagnostic efficacy of ABVS quantitative scoring and HHUS in the training set. The variable with higher efficacy was selected for inclusion in the multivariable logistic regression analysis. Based on the identified independent predictive factors,a nomogram was constructed to quantify the malignancy risk of breast lesions. The nomogram was evaluated and validated using the area under the ROC curve(AUC),calibration curve and clinical decision curve analysis(DCA). Results:The AUC for ABVS quantitative scoring and HHUS in distinguishing benign and malignant breast lesions were 0.941 and 0.903,respectively,with a statistically significant difference( Z=2.081, P=0.037). Multivariate Logistic regression analysis showed that age,ABVS quantitative score and elasticity score were independent predictors for the identification of benign and malignant breast lesions(all P<0.05). A nomogram was constructed based on the aforementioned independent predictive factors. The AUC for the nomogram were 0.968 in the training set and 0.943 in the validation set,indicating good discrimination. The calibration curve indicated that the predicted probabilities from the nomogram were in good agreement with the actual outcomes. DCA indicated strong clinical applicability of the nomogram. Conclusions:The nomogram based on ABVS quantitative scores,elasticity scores,and age demonstrates high diagnostic value,providing a novel method for preoperative assessment of the malignancy risk of breast lesions.

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