Analysis of influential factors of axillary lymph node metastasis in Luminal type A breast cancer patients and con-struction of nomogram prediction model

Gao Xinran; Jia Baoqing; Guo Jiaxin; Liu Junbiao

doi:10.3969/j.issn.1671-6450.2025.03.009

Abstract：Objective To investigate the influencing factors of axillary lymph node metastasis(ALNM)in Luminal type A breast cancer patients and to establish a nomogram prediction model.Methods One hundred and thirty-five pa-tients with Luminal A breast cancer admitted to the Department of Breast Oncology Surgery of the People's Hospital of In-ner Mongolia Autonomous Region from January 2019 to January 2024 were selected for the study,and they were divided into 94 cases of the modelling group and 41 cases of the validation group according to the ratio of 7:3.According to the occurrence or non-occurrence of ALNM after surgery,patients in the modelling group were divided into 43 cases of the ALNM subgroup and no ALNM subgroup of 51 cases.Multifactorial logistic regression was used to analyse the influen-cing factors of ALNM in patients with Luminal A breast cancer;R software was used to construct the column chart model;ROC curves were used to assess the discriminatory degree of the column chart model in predicting ALNM in patients with Luminal A breast cancer;and clinical decision curves were used to assess the clinical application value of the column chart model.Results The incidence of ALNM was 45.19％(61/135)in 135 patients with Luminal A breast cancer and 45.74％(43/94)in 94 patients in the modelling group.The ALNM subgroup had a higher proportion of age＜50 years,maximum tumour diameter＞2 cm,histological grade Ⅱ-Ⅲ,vascular invasion,multifocal tumour,and p53 gene mutation than the no ALNM subgroup,(x2/P=15.474,12.163,14.026,12.983,21.803,15.159,all P＜0.001);multifactorial logistic regression analysis showed that age＜50 years,maximum tumour diameter＞2 cm,histological grading Ⅱ-Ⅲ,vascular invasion,multifocal tumour,and p53 gene mutation were the independent risk factors for ALNM in patients with Luminal A breast cancer[OR(95％CI)=2.531(1.336-4.975),3.120(1.095-8.886),3.657(1.602-8.346),5.208(1.854-14.633),14.718(2.073-104.485),6.807(1.934-19.157)],and constructed a column-line graph prediction model;the validation results showed that the area under the curve(AUC)was 0.960(95％CI=0.916-0.999)for the modelling group,and the AUC was 0.967(95％CI=0.918-0.999)for the validation group.The slopes of the calibration curves of the modelling and validation groups were close to 1.The H-L test was x2=7.067(P=0.701)in the modelling group and x2=6.923(P=0.706)in the validation group;from the DCA curves,it was clear that when the probability of the high-risk threshold was between 0.08 and 0.96,the col-umn-line diagram model for assessing ALNM in patients with Luminal A breast cancer had a clinical use value is high.Con-clusion Age＞50,maximum tumour diameter＞2 cm,histological grading Ⅱ-Ⅲ,vascular invasion,multifocal tumour,and p53 gene mutation are the risk factors of ALNM in patients with Luminal A breast cancer,and the column-line graph model constructed in this way has some clinical value in predicting ALNM in patients with Luminal A breast cancer.