Development of a recurrence risk prediction model for granulomatous lobular mastitis after surgery: based on logistic regression analysis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CHEN Jin , WU Ruiyang , DAI Jiefang ,  ZHANG Haiyan

Department of Breast and Thyroid Surgery, Sichuan Provincial Hospital for Women and Children; Department of Ultrasound, Sichuan Provincial Hospital for Women and Children, Chengdu 610041, P. R. China;

Corresponding author：

ZHANG Haiyan, Email: 446917513@qq.com

Keywords：

systemic inflammatory index; Granuloma; Mastitis; recrudescence

DOI：

10.7507/1007-9424.202412099

Video：

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Objective To construct a prediction model for the postoperative recurrence risk of granulomatous lobular mastitis (GLM) based on multiple systemic inflammatory indicators and clinicopathologic characteristics, with the aim of guiding clinical treatment. Methods The GLM patients who underwent lesion resection at Sichuan Provincial Maternal and Child Health Hospital from January 2017 to March 2024 were retrospectively collected. The univariate and multivariate logistic regression analyses were used to screen the risk factors for recurrence after GLM lesion resection, and a nomogram prediction model was constructed based on the risk factors. The test level was set at α=0.05. Results A total of 533 patients with GLM were included in this study, and 118 cases (22.1%) developed postoperative recurrence. The results of multivariate analysis showed that the no taking oral bromocriptine, having microabscess formation in postoperative pathological examination results, systemic immune inflammation index (SII) >789.0×10⁹/L, and immunoglobulin E (IgE) >64.4 U/mL were the independent risk factors for recurrence after GML. Based on this, the nomogram predicting recurrence risk was constructed. The area under the receiver operating characteristic curve (95%CI) was 0.913 (0.895, 0.932), and its sensitivity and specificity were 90.5% and 88.9%, respectively. The calibration curve showed that the probability of recurrence after GML predicted by using the nomogram was highly consistent with the actual occurrence probability. The decision curve analysis showed that the nomogram had a good clinical net benefit. Conclusions The results of this study suggest that no taking bromocriptine orally, having microabscess formation in postoperative pathological examination results, SII, and IgE are risk factors for recurrence in GLM patients undergoing lesion resection. The nomogram model for predicting postoperative recurrence of GLM constructed based on these risks has good efficacy and provides a reference for the early treatment and management of GLM.

1.	Kaviani A, Vasigh M, Omranipour R, et al. Idiopathic granulomatous mastitis: Looking for the most effective therapy with the least side effects according to the severity of the disease in 374 patients in Iran. Breast J, 2019, 25(4): 672-677.
2.	张超杰, 胡金辉, 赵希. 肉芽肿性小叶性乳腺炎诊治湖南专家共识(2021版). 中国普通外科杂志, 2021, 30(11): 1257-1273.
3.	Templeton AJ, Ace O, McNamara MG, et al. Prognostic role of platelet to lymphocyte ratio in solid tumors: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev, 2014, 23(7): 1204-1212.
4.	程泽伟, 梁贻泽, 闫治波, 等. 炎症营养指标评估胃癌新辅助化疗疗效及预后研究进展. 中国实用外科杂志, 2024, 44(4): 477-480.
5.	Li W, Ma G, Deng Y, et al. Systemic immune-inflammation index is a prognostic factor for breast cancer patients after curative resection. Front Oncol, 2021, 11: 570208. doi: 10.3389/fonc.2021.570208.
6.	Jiang C, Lu Y, Zhang S, et al. Systemic immune-inflammation index is superior to neutrophil to lymphocyte ratio in prognostic assessment of breast cancer patients undergoing neoadjuvant chemotherapy. Biomed Res Int, 2020, 2020: 7961568. doi: 10.1155/2020/7961568.
7.	唐欣. 肉芽肿性乳腺炎的病因学研究进展. 中国妇幼保健, 2018, 33(7): 1672-1675.
8.	Bi J, Li Z, Lin X, et al. Etiology of granulomatous lobular mastitis based on metagenomic next-generation sequencing. Int J Infect Dis, 2021, 113: 243-250.
9.	Tasci HI, Turk E, Erinanc OH, et al. Factors affecting recurrence of idiopathic granulomatous mastitis. J Coll Physicians Surg Pak, 2022, 32(2): 161-165.
10.	陈丽娟, 曹茵, 袁惠玲, 等. 溴隐亭联合激素治疗伴高泌乳素血症肉芽肿性乳腺炎的疗效观察. 广东医科大学学报, 2021, 39(6): 705-707.
11.	秦威, 李林, 王芳, 等. 肉芽肿性乳腺炎临床诊治分析. 肿瘤基础与临床, 2017, 30(5): 427-429.
12.	许露, 王高华, 张丽丽, 等. 精神病药物相关性肉芽肿性乳腺炎的机制及治疗进展. 中国现代普通外科进展, 2024, 27(5): 382-386.
13.	Aljawder AAA, Li JJX, Ng JKM, et al. Idiopathic granulomatous mastitis and cystic neutrophilic granulomatous mastitis: two sides of the same coin or distinct entities?. Pathology, 2023, 55(3): 335-341.
14.	Troxell ML, Gordon NT, Doggett JS, et al. Cystic neutrophilic granulomatous mastitis: association with gram-positive bacilli and corynebacterium. Am J Clin Pathol, 2016, 145(5): 635-645.
15.	Dávila-Collado R, Jarquín-Durán O, Solís-Vallejo A, et al. Elevated monocyte to lymphocyte ratio and increased mortality among patients with chronic kidney disease hospitalized for COVID-19. J Pers Med, 2021, 11(3): 224. doi: 10.3390/jpm11030224.
16.	Zeng M, Liu Y, Liu F, et al. J-shaped association of platelet-to-lymphocyte ratio with 5-year mortality among patients with chronic kidney disease in a prospective cohort study. Int Urol Nephrol, 2020, 52(10): 1943-1957.
17.	Hu B, Yang XR, Xu Y, et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res, 2014, 20(23): 6212-6222.
18.	Huang H, Liu Q, Zhu L, et al. Prognostic value of preoperative systemic immune-inflammation index in patients with cervical cancer. Sci Rep, 2019, 9(1): 3284. doi: 10.1038/s41598-019-39150-0.
19.	Chen JH, Zhai ET, Yuan YJ, et al. Systemic immune-inflammation index for predicting prognosis of colorectal cancer. World J Gastroenterol, 2017, 23(34): 6261-6272.
20.	Xiao S, Wang Z, Zuo R, et al. Association of systemic immune inflammation index with all-cause, cardiovascular disease, and cancer-related mortality in patients with cardiovascular disease: a cross-sectional study. J Inflamm Res, 2023, 16: 941-961.
21.	Ye C, Yuan L, Wu K, et al. Association between systemic immune-inflammation index and chronic obstructive pulmonary disease: a population-based study. BMC Pulm Med, 2023, 23(1): 295. doi: 10.1186/s12890-023-02583-5.
22.	高晓丽, 吴斌. 系统性炎症指标与局部晚期乳腺癌新辅助化疗后病理完全缓解的关系. 中国普外基础与临床杂志, 2023, 30(4): 443-449.
23.	Azzam MI, Alnaimat F, Al-Nazer MW, et al. Idiopathic granulomatous mastitis: clinical, histopathological, and radiological characteristics and management approaches. Rheumatol Int, 2023, 43(10): 1859-1869.
24.	Ogawa Y, Muto Y, Kinoshita M, et al. Neutrophil extracellular traps in skin diseases. Biomedicines, 2021, 9(12): 1888. doi:10.3390/ biomedicines9121888. doi: 10.3390/biomedicines9121888.
25.	宿琦琦, 刘晓菲, 李书园, 等. 特发性肉芽肿乳腺炎诊疗研究进展. 中国现代普通外科进展, 2023, 26(6): 489-492.
26.	Zhang Y, Liu WD, Chen YJ, et al. Exploring the pathogenesis of idiopathic granulomatous mastitis based on the prolactin theory. Med Theory Hypothesis, 2023, 6(1): 5-9. Zhang, Y, Liu, W, Chen, Y, et al. Exploring the pathogenesis of idiopathic granulomatous mastitis based on the prolactin theory Med Theor Hypothesis. 2023; 6 (1): 2. doi: 10.53388/tmrth202303002.
27.	宋爽, 梁燕, 唐鹏, 等. 皮肤坏死性肉芽肿性乳腺炎合并糖尿病一例. 中华乳腺病杂志(电子版), 2021, 15(5): 327-328.

1. Kaviani A, Vasigh M, Omranipour R, et al. Idiopathic granulomatous mastitis: Looking for the most effective therapy with the least side effects according to the severity of the disease in 374 patients in Iran. Breast J, 2019, 25(4): 672-677.
2. 张超杰, 胡金辉, 赵希. 肉芽肿性小叶性乳腺炎诊治湖南专家共识(2021版). 中国普通外科杂志, 2021, 30(11): 1257-1273.
3. Templeton AJ, Ace O, McNamara MG, et al. Prognostic role of platelet to lymphocyte ratio in solid tumors: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev, 2014, 23(7): 1204-1212.
4. 程泽伟, 梁贻泽, 闫治波, 等. 炎症营养指标评估胃癌新辅助化疗疗效及预后研究进展. 中国实用外科杂志, 2024, 44(4): 477-480.
5. Li W, Ma G, Deng Y, et al. Systemic immune-inflammation index is a prognostic factor for breast cancer patients after curative resection. Front Oncol, 2021, 11: 570208. doi: 10.3389/fonc.2021.570208.
6. Jiang C, Lu Y, Zhang S, et al. Systemic immune-inflammation index is superior to neutrophil to lymphocyte ratio in prognostic assessment of breast cancer patients undergoing neoadjuvant chemotherapy. Biomed Res Int, 2020, 2020: 7961568. doi: 10.1155/2020/7961568.
7. 唐欣. 肉芽肿性乳腺炎的病因学研究进展. 中国妇幼保健, 2018, 33(7): 1672-1675.
8. Bi J, Li Z, Lin X, et al. Etiology of granulomatous lobular mastitis based on metagenomic next-generation sequencing. Int J Infect Dis, 2021, 113: 243-250.
9. Tasci HI, Turk E, Erinanc OH, et al. Factors affecting recurrence of idiopathic granulomatous mastitis. J Coll Physicians Surg Pak, 2022, 32(2): 161-165.
10. 陈丽娟, 曹茵, 袁惠玲, 等. 溴隐亭联合激素治疗伴高泌乳素血症肉芽肿性乳腺炎的疗效观察. 广东医科大学学报, 2021, 39(6): 705-707.
11. 秦威, 李林, 王芳, 等. 肉芽肿性乳腺炎临床诊治分析. 肿瘤基础与临床, 2017, 30(5): 427-429.
12. 许露, 王高华, 张丽丽, 等. 精神病药物相关性肉芽肿性乳腺炎的机制及治疗进展. 中国现代普通外科进展, 2024, 27(5): 382-386.
13. Aljawder AAA, Li JJX, Ng JKM, et al. Idiopathic granulomatous mastitis and cystic neutrophilic granulomatous mastitis: two sides of the same coin or distinct entities?. Pathology, 2023, 55(3): 335-341.
14. Troxell ML, Gordon NT, Doggett JS, et al. Cystic neutrophilic granulomatous mastitis: association with gram-positive bacilli and corynebacterium. Am J Clin Pathol, 2016, 145(5): 635-645.
15. Dávila-Collado R, Jarquín-Durán O, Solís-Vallejo A, et al. Elevated monocyte to lymphocyte ratio and increased mortality among patients with chronic kidney disease hospitalized for COVID-19. J Pers Med, 2021, 11(3): 224. doi: 10.3390/jpm11030224.
16. Zeng M, Liu Y, Liu F, et al. J-shaped association of platelet-to-lymphocyte ratio with 5-year mortality among patients with chronic kidney disease in a prospective cohort study. Int Urol Nephrol, 2020, 52(10): 1943-1957.
17. Hu B, Yang XR, Xu Y, et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res, 2014, 20(23): 6212-6222.
18. Huang H, Liu Q, Zhu L, et al. Prognostic value of preoperative systemic immune-inflammation index in patients with cervical cancer. Sci Rep, 2019, 9(1): 3284. doi: 10.1038/s41598-019-39150-0.
19. Chen JH, Zhai ET, Yuan YJ, et al. Systemic immune-inflammation index for predicting prognosis of colorectal cancer. World J Gastroenterol, 2017, 23(34): 6261-6272.
20. Xiao S, Wang Z, Zuo R, et al. Association of systemic immune inflammation index with all-cause, cardiovascular disease, and cancer-related mortality in patients with cardiovascular disease: a cross-sectional study. J Inflamm Res, 2023, 16: 941-961.
21. Ye C, Yuan L, Wu K, et al. Association between systemic immune-inflammation index and chronic obstructive pulmonary disease: a population-based study. BMC Pulm Med, 2023, 23(1): 295. doi: 10.1186/s12890-023-02583-5.
22. 高晓丽, 吴斌. 系统性炎症指标与局部晚期乳腺癌新辅助化疗后病理完全缓解的关系. 中国普外基础与临床杂志, 2023, 30(4): 443-449.
23. Azzam MI, Alnaimat F, Al-Nazer MW, et al. Idiopathic granulomatous mastitis: clinical, histopathological, and radiological characteristics and management approaches. Rheumatol Int, 2023, 43(10): 1859-1869.
24. Ogawa Y, Muto Y, Kinoshita M, et al. Neutrophil extracellular traps in skin diseases. Biomedicines, 2021, 9(12): 1888. doi:10.3390/ biomedicines9121888. doi: 10.3390/biomedicines9121888.
25. 宿琦琦, 刘晓菲, 李书园, 等. 特发性肉芽肿乳腺炎诊疗研究进展. 中国现代普通外科进展, 2023, 26(6): 489-492.
26. Zhang Y, Liu WD, Chen YJ, et al. Exploring the pathogenesis of idiopathic granulomatous mastitis based on the prolactin theory. Med Theory Hypothesis, 2023, 6(1): 5-9. Zhang, Y, Liu, W, Chen, Y, et al. Exploring the pathogenesis of idiopathic granulomatous mastitis based on the prolactin theory Med Theor Hypothesis. 2023; 6 (1): 2. doi: 10.53388/tmrth202303002.
27. 宋爽, 梁燕, 唐鹏, 等. 皮肤坏死性肉芽肿性乳腺炎合并糖尿病一例. 中华乳腺病杂志(电子版), 2021, 15(5): 327-328.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Latest ArticlesDevelopment of a recurrence risk prediction model for granulomatous lobular mastitis after surgery: based on logistic regression analysis

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