RU2336822C1 - Method for mammary gland cancer forecasting - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: blood test of patient is carried out. In addition to this following indicators are defined at examination: age, social status, accompanying diseases, quantity of blood monocytes, speed of subsidence of erythrocytes (SSE), total bilirubin of blood, blood creatin, specific weight of urine, urine reaction. Then forecasting index (FI) for each indicator is defined. Age at marker - before 20 years FI equal to (0) is established in the system, at marker 20-29 years - equal to (-10), at marker 30-39 years - equal to (-7), at marker 40-49 years - equal to(+4), at marker 50-59 years - equal to (+3), at marker 60-69 years - equal to (+2), at marker 70-79 years - equal to (+4), at marker 80 and more years - equal to (-3). Social status at marker - workers FI equal to (+4) is established in the system, at marker employees - equal to (-1), at marker pupils - equal to (0), at marker the unemployed - equal to (-12), at marker pensioners and disabled workers (DW) - equal to (+1). Accompanying diseases at marker - diseases of gastroenteric tract (GET) FI equal to (-10) is established in the system, at marker of disease of cardiovascular system - equal to (+2), at marker of disease of endocrine system - equal to (+1.5), at marker of disease of respiratory system - equal to (0), at marker of disease of locomotor apparatus - equal to (0), at marker of disease of urogenital system - equal to (-13), at marker of combination of accompanying diseases - equal to (-1), at marker of absence of accompanying diseases - equal to (+2). Blood monocytes, at marker - not present, FI equal to (0) is established in the system, at marker of 1-3% - equal to (-2.5), at marker of 4-6% - equal to (+2), at marker of 7-10% - equal to (+2.5), at marker more than 10% - equal to (0). Blood sedimentation rate at marker - 1-10 mm per hour FI equal to (-1) is established in the system, at marker of 11-20 mm per hour - equal to (-3), at marker of 21-30 mm per hour - equal to (+7), at marker of 31-40 mm per hour - equal to (0), at marker more than 40 mm per hour - equal to (0). Total bilirubin at marker - less than 8.8 mcmol/l FI equal to (0) is established in the system, at marker of 8.8-17 mcmol per l. - equal to (-1), at marker more than 17 mcmol per l.- equal to (+5.5). Creatinin at marker - less than 0.07 mcmol per l. FI equal to (+11) is established in the system, at marker 0.07-0.17 - equal to (-3), at marker more than 0.17 mcmol/l - equal to (0). Specific weight of urine at marker less-1008 FI equal to (0) is established in the system, at marker 1008-1026 - equal to (+2), at marker more than 1026 - equal to (+6). Urine reaction at marker - sour, FI equal to (+3) is established in the system, at marker neutral - equal to (-3), at marker alkaline - equal to (-12). If FI sum is from (-54.5) to (-21.5) low probability of cancer of mammary gland is predicted, if the sum is from (+11) to (+44.5) high probability of cancer of mammary gland is predicted.

EFFECT: working out simple means of mammary gland cancer diagnostics initially.

4 tbl, 3 ex

Description

The invention relates to medicine, namely to oncology, and can be used as a method for early diagnosis of breast cancer.

A known method for predicting the generalization of breast cancer [patent RU 2204836, IPC 7 G01N 33/48; publ. BIMP No. 14, 05.20.2003, p.496, Kucherova T.I., Vladimirova L.Yu., Nerodo G.A., Bineeva V.A., Verkhovtseva A.I., Shatokhina O.N.], selected as a prototype. In this method, a diagnostic observation of patients with breast cancer is performed. The platelet activity of MAO-B in blood plasma is determined, which provides preclinical detection of breast cancer generalization. With a decrease in platelet activity of MAO-B by 4-6 times in relation to the norm, the generalization of the process is predicted.

The first disadvantage of the proposed method is the use as a marker of only one indicator - platelet activity of MAO-B in blood plasma.

The second disadvantage is the use of the method in relation to patients with breast cancer.

The third disadvantage of the method is the predominant information content of the proposed platelet activity indicator MAO-B during the generalization of the process in the presence of distant metastases, which makes it impossible to use the method in the early diagnosis of breast cancer.

The objective of the invention is to develop a method for predicting breast cancer at the stage of laboratory examination by increasing the number of indicators.

The problem is achieved in that the method for predicting breast cancer includes a blood test of the patient. Additionally, during the examination, indicators are determined: age, social status, concomitant diseases, the number of blood monocytes, erythrocyte sedimentation rate (ESR), total blood bilirubin, blood creatinine, specific gravity of the urine, urine reaction. Then determine the prognostic factor (PC) for each indicator. In the system, the age with a marker up to 20 years is set to PC equal to (0), with a marker 20-29 years old - (-10), with a marker 30-39 years old - (-7), with a marker 40-49 years old - ( +4), with a marker of 50-59 years old - equal to (+3), with a marker of 60-69 years old - equal (+2), with a marker of 70-79 years old - equal (+4), with a marker of 80 and more years - equal to (-3). In the system, social status with a marker, workers set the PC to (+4), with a marker employees - equal (-1), with a marker students - equal (0), with a marker unemployed - equal (-12), with a marker pensioners and disabled people (Engineering) - equal to (+1). In the system, concomitant diseases with a marker of a disease of the gastrointestinal tract (GIT) set the PC to (-10), with a marker of a disease of the cardiovascular system - (+2), with a marker of a disease of the endocrine system - equal (+1.5), with a marker of a disease of the respiratory system - equal to (0), with a marker of a disease of the musculoskeletal system - equal to (0), with a marker of a disease of the genitourinary system - equal (-13), with a marker, a combination of concomitant diseases - equal to (-1), with a marker the absence of concomitant diseases - equal (+2). In the system, blood monocytes with a no marker set the PC to equal (0), with a 1-3% marker - equal to (-2.5), with a 4-6% marker - equal (+2), with a 7-10% marker (+2.5), with a marker of more than 10% - equal to (0). In the system, the erythrocyte sedimentation rate with a marker of 1-10 mm / h is set to PC equal to (-1), with a marker of 11-20 mm / h - equal to (-3), with a marker of 21-30 mm / h - equal to (+7 ), with a marker of 31-40 mm / h - equal to (0), with a marker of more than 40 mm / h - equal to (0). In the system, total bilirubin with a marker of less than 8.8 μmol / L is set to PC equal to (0), with a marker of 8.8-17 μmol / L - equal to (-1), with a marker of more than 17 μmol / L - equal to (+5, 5). In the creatinine system, when the marker is less than 0.07 mmol / L, the PC is set to (+11), when the marker is 0.07-0.17 - equal to (-3), when the marker is more than 0.17 mmol / L - equal to (0 ) In the system, the specific gravity of urine with a marker less than 1008 sets the PC to equal (0), with a marker 1008-1026 - equal to (+2), with a marker of more than 1026 - equal to (+6). In the system, the urine reaction with a sour marker is set to PC equal to (+3), with a neutral marker - equal to (-3), with an alkaline marker - equal to (-12). With a PC sum of (-54.5) to (-21.5), a low probability of breast cancer is predicted, with a sum of (+11) to (+44.5) a high probability of breast cancer is predicted.

The novelty of the method

This method allows to predict breast cancer at the stage of laboratory examination and is used in the early diagnosis of breast cancer, using indicators such as age, social status, concomitant diseases, blood monocytes, erythrocyte sedimentation rate, total blood bilirubin, blood creatinine, specific gravity urine, urine reaction. The method is characterized by accessibility and ease of calculation.

The significance of the indicators was proved using the non-parametric chi-square test (Table 1).

Reliably significant indicators were: age, social status, concomitant diseases, erythrocyte sedimentation rate, blood monocytes, total bilirubin, blood creatinine, specific gravity and urine reaction. No reliable significance was found for other indicators.

Table 1 Indicators Reliability (Chi-square) Age 22.29; p <0.002 Blood type 0.3; p> 0.05 Rhesus factor 0.24; p> 0.05 Social status 8.21; p <0.05 Accompanying illnesses 17.29; p <0.05 Hemoglobin 3.35; p> 0.05 Red blood cells 6.2; p> 0.05 Erythrocyte sedimentation rate 11.53; p <0.05 White blood cells 4.7; p> 0.05 Monocytes 20.67; p <0.002 Eosinophils 2.1; p> 0.05 Lymphocytes 4.3; p> 0.05 Urine specific gravity 11.59; p <0.01 Urine reaction 27.04; p <0.002 Protein in the urine 0.61; p> 0.05 The amount of epithelium in the urine 0.53; p> 0.05 White blood cell count in urine 2.4; p> 0.05 Total protein 2.09; p> 0.05 Total bilirubin 7.44; p <0.05 Urea 0.21; p> 0.05 Creatinine 16.56; p <0.002 Glucose 0.064; p> 0.05

To predict breast cancer, the likelihood ratio method was used (Shigan E.N., 1973), following which the probabilities (P) for each factor in the group of patients with breast cancer and the control group (healthy women) were initially calculated, and then the probability ratios of the two groups were found to obtain likelihood ratios (KP) (Table 2).

The obtained likelihood coefficient is logarithmized and multiplied by 10, followed by rounding to integer values (Gubler E.V., 1964) and obtaining the prognostic coefficient (PC) (Table 3)

table 2 Indicators Breast Cancer Patients The control Likelihood ratio (KP) n P _cancer n P _cont Age: - up to 20 years 0 0 0 0 0 - 20-29 years old one 0.02 5 0.2 0.1 - 30-39 years old four 0,07 8 0.32 0.2 - 40-49 years old 17 0.28 3 0.12 2,3 - 50-59 years old fourteen 0.23 3 0.12 1.9 - 60-69 years old 12 0.19 3 0.12 1,6 - 70-79 years old 12 0.19 2 0.08 2,3 - 80 and more one 0.02 one 0.04 0.5 Total 61 1,0 25 1,0 Social Status: - workers 12 0.2 2 0.08 2,5 - employees 21 0.34 10 0.4 0.85 - students 0 0 0 0 0 - unemployed one 0.01 four 0.16 0.06 - pensioners and engineers 27 0.45 9 0.36 1.25 Total 61 1,0 25 1,0 Related diseases: - GIT one 0.01 3 0.12 0.08 - CCC fifteen 0.25 four 0.16 1,6 - Endocrine system 2 0,03 one 0.04 0.75 - respiratory system 3 0.05 0 0 0 - Musculoskeletal apparatus four 0,07 0 0 0 - Genitourinary system one 0.01 5 0.2 0.05 - The combination of diseases 12 0.2 6 0.24 0.83 - No disease 23 0.38 6 0.24 1,6 Total 61 1,0 25 1,0 Monocytes (%): - no 0 0 6 0.24 0 - 1-3 eleven 0.18 8 0.32 0.56 - 4-6 24 0.4 6 0.24 1,6 - 7-10 21 0.34 5 0.2 1.7 -> 10 5 0.08 0 0 0 Total 61 1,0 25 1,0 ESR (mm / h); - 1-10 mm 22 0.36 12 0.48 0.75 - 11-20 mm fifteen 0.25 12 0.48 0.52 - 21-30 mm 12 0.2 one 0.04 5 - 31-40 mm 10 0.16 0 0 0 -> 40 mm 2 0,03 0 0 0 Total 61 1,0 25 1,0 Urine specific gravity: - less than 1008 0 0 10 0.4 0 - 1008-1026 51 0.83 fourteen 0.56 1.48 - more than 1026 10 0.17 one 0.04 4.25 Total 61 1,0 25 1,0 Urine reaction - sour 58 0.95 12 0.48 1.98 - neutral one 0.02 one 0.04 0.5 - alkaline 2 0,03 12 0.48 0.06 Total 61 1,0 25 1,0 Total bilirubin (μmol / L): -> 8.8 7 0.11 0 0 0 - 8.8-17 46 0.75 24 0.96 0.78 -> 17 8 0.14 one 0.04 3,5 Total 61 1,0 25 1,0 Creatinine (mmol / L): -> 0.07 33 0.54 one 0.04 13.5 - 0.07-0.17 28 0.46 24 0.96 0.48 -> 0.17 0 0 0 0 0 Total 61 1,0 25 1,0

Table 3 Indicators Prediction coefficient (PC) Age: - up to 20 years 0 - 20-29 years old - 10 - 30-39 years old - 7 - 40-49 years old +4 - 50-59 years old +3 - 60-69 years old +2 - 70-79 years old +4 - 80 and more - 3 Social Status: - workers +4 - employees -one - students 0 - unemployed -12 - pensioners and engineers +1 Accompanying illnesses: - GIT -10 - CCC +2 - Endocrine system +1.5 - respiratory system 0 - Musculoskeletal 0 apparatus - Genitourinary system -13 - The combination of diseases -one - No disease +2 Monocytes (%): - no 0 - 1-3 -2.5 - 4-6 +2 - 7-10 +2.5 -> 10 0 ESR (mm / h): - 1-10 mm - one - 11-20 mm -3 - 21-30 mm +7 - 31-40 mm 0 -> 40 mm 0 Total bilirubin (μmol / L): -> 8.8 0 - 8.8-17 -one -> 17 +5.5 Creatinine (mmol / L): -> 0.07 +11 - 0.07-0.17 -3 -> 0.17 0 Urine specific gravity: - less than 1008 0 - 1008-1026 +2 - more than 1026 +6 Urine reaction: - sour +3 - neutral -3 - alkaline -12

According to the results of the study, the following indicators were uninformative: in the system, age - up to 20 years, in the system social status - students, in the system of concomitant diseases - diseases of the respiratory system, musculoskeletal system, in the monocyte system - no more than 10%, in the ESR system - 31-40 mm / h and more than 40 mm / h, in the system total bilirubin - less than 8.8 mmol / l, in the creatinine system - more than 17 mmol / l, in the system the specific gravity of urine is less than 1008.

The highest probability of breast cancer is predicted taking into account the following indicators: age 40-49 years, 70-79 years, social status - workers, with the absence of concomitant diseases or diseases of the cardiovascular system, blood monocytes - 7-10%, ESR - 21- 30 mm / h, acid reaction of urine, total bilirubin more than 17 μmol / L, blood creatinine less than 0.07 mmol / L, specific gravity of urine more than 1026.

Three groups of probability of breast cancer are distinguished by first adding the minimum and then the maximum PC values for all indicators. The obtained range, between the sum of the largest and smallest PC values, is divided into three equal parts corresponding to the probability groups of breast cancer (Table No. 4).

Table 4 Breast Cancer Probability Groups Ranges of sums of prognostic factors % Low probability -54.5 to -21.5 0-20% Average probability From -21 to +11 30-70% High probability From +10.5 to +44.5 75-90%

Thus, the greatest probability of prognosis of breast cancer with the amount of PC from 10.5 to 44.5.

The method is as follows. Patients are questioned with the specification of age, social status, and the presence of concomitant diseases. A morphological study of blood cells is carried out, with the counting of monocytes using a hematological analyzer (ADVIA 60) and a microscope, the erythrocyte sedimentation rate (ESR) is determined using the Panchenkov micromethod. The specific gravity, reaction (pH) of urine is determined on an electronic analyzer (Combilyzer PLUS). Total blood bilirubin is determined by the Yendrassik-Grof method, creatinine is determined by the calorimetric method. Data obtained by the indicated methods are analyzed. The diagnostic coefficient (DC) is determined.

Example 1

Patient K., 53 years old, lives in the city, working. She complained of nodular formation in the right mammary gland. Chronic somatic diseases denied. Several years ago, an operation was performed for fibroadenoma of the left breast. After examination by an oncologist, the diagnosis was made: breast cancer, an aspiration biopsy was performed to verify the diagnosis. A general analysis of blood and urine, a biochemical blood test (glucose, total bilirubin, total protein, creatinine) was performed. General blood test results: Red blood cells - 3.81 · 10 ¹² , hemoglobin - 108 g / l, ESR - 5 mm / h, eosinophils - 7%, lymphocytes - 31%, monocytes - 10%, white blood cells - 3.8 · 10 ⁹ . The results of a general analysis of urine: acid reaction, protein - neg., Sugar - neg., Specific gravity - 1016, epithelium - single in the field of vision, white blood cells - single in the field of vision. Results of a biochemical blood test: creatinine - 0.049 mmol / L, total bilirubin - 17.5 μmol / L, total protein - 64 g / L, glucose - 5.1 mmol / L.

Age - +3

Social status - +4

Concomitant diseases - +2

Monocytes - +2.5

ESR - (-1)

Urine Reaction - +3

The specific gravity of urine is +2

Total bilirubin - +5.5

Creatinine - +11

Sum PC = 3 + 4 + 2 + 2.5 + (- 1) + 3 + 2 + 5.5 + 11 = 32

The resulting amount of PK corresponds to a high probability group for breast cancer. The result of cytological examination: breast cancer.

Example 2

Patient L., 66 years old, lives in the city, retired. She complained of nodular formation in the left mammary gland. About 5 years old suffers from hypertension, chronic bronchitis. An oncological history is not burdened. After examination by an oncologist, he was diagnosed with nodular mastopathy. Performed aspiration puncture biopsy, general blood count, general urine analysis, blood biochemistry (glucose, total bilirubin, creatinine, total protein). The results of a general blood test: red blood cells - 3.73 · 10 ¹² , hemoglobin - 123 g / l, ESR - 15 mm / h, eosinophils - 2%, lymphocytes - 12%, monocytes - 7%, leukocytes - 5.2 · 10 ⁹ . The results of a general urine analysis: acid reaction, protein - neg., Sugar - neg., Specific gravity - 1015, epithelium - 1-2 in the field of view, white blood cells - single in the field of view. Results of a biochemical blood test: creatinine - 0.069 mmol / L, total bilirubin - 11.9 μmol / L, total protein - 87.4 g / L, glucose - 5.6 mmol / L.

Age - +2

Social Status - +1

Concomitant diseases - +2

Monocytes - +2.5

ESR - (-3)

Urine Reaction - +1

The specific gravity of urine is +2

Total Bilirubin - (-1)

Creatinine - +11

Sum PC = 2 + 1 + 2 + 2.5 + (- 3) + 1 + 2 + (- 1) + 11 = 17.5

The resulting amount of PK corresponds to a high probability group for breast cancer. The result of cytological examination: breast cancer.

Example 3

Patient B., 58 years old, lives in the city, retired. She complained of pain and tightness in the right mammary gland. History of uterine fibroids, denies other diseases. After examination by an oncologist, she was diagnosed with mastopathy? Performed aspiration puncture biopsy, general blood count, general urinalysis, biochemical blood test (glucose, total bilirubin, creatinine, total protein). General blood test results: erythrocytes - 4.78 · 10 ¹² , hemoglobin - 155 g / l, ESR - 6 mm / h, eosinophils - 2%, lymphocytes - 32%, monocytes - 7%, leukocytes - 4.8 · 10 ⁹ . The results of a general urinalysis: acid reaction, protein - neg., Sugar - neg., Specific gravity - 1011, epithelium - 1-2 in the field of view, white blood cells - single in the field of view. Results of a biochemical blood test: creatinine - 0.11 mmol / L, total bilirubin - 13.0 μmol / L, total protein - 80 g / L, glucose - 6.3 mmol / L.

Age - +3

Social Status - +1

Concomitant diseases - +2

Monocytes - +2.5

ESR - (-1)

Urine Reaction - +1

The specific gravity of urine is +2

Total Bilirubin - (-1)

Creatinine - (-3)

Sum PC = 3 + 1 + 2 + 2.5 + (- 1) + 1 + 2 + (- 1) + (- 3) = 6.5

The resulting amount of PC corresponds to the group of average (doubtful) probability of breast cancer. The result of cytological examination: proliferative mastopathy.

Thus, this method allows to predict breast cancer at the stage of laboratory examination and is used in the early diagnosis of breast cancer, characterized by accessibility and ease of implementation.

Claims (1)

A method for predicting breast cancer, including a patient’s blood test, characterized in that additionally, during the examination, indicators are determined: age, social status, concomitant diseases, blood monocytes, erythrocyte sedimentation rate, total bilirubin, blood creatinine, specific gravity of urine, urine reaction, then determine the prognostic coefficient (PC) for each indicator, namely, in the system age with a marker - up to 20 years, set the PC to (0), with a marker of 20-29 years - (-10), with a marker of 30-39 years - equal (-7) with a marker of 40-49 years old - equal (+4), with a marker of 50-59 years old - equal (+3), with a marker of 60-69 years old - equal (+2), with a marker of 70-79 years old - equal (+4) ), with a marker of 80 years or more - equal to (-3); in the system, social status with a marker - workers set the PC to equal (+4), with a marker employees - equal (-1), with a marker students - equal (0), with a marker unemployed - equal (-12), with a marker pensioners and disabled labor (Engineering) - equal to (+1); in the system, concomitant diseases with a marker - diseases of the gastrointestinal tract (GIT) set the PC equal to (-10), with a marker of a disease of the cardiovascular system - equal (+2), with a marker of a disease of the endocrine system - equal (+1.5) , with a marker of a disease of the respiratory system - equal to (0), with a marker of a disease of the musculoskeletal system - equal to (0), with a marker of a disease of the genitourinary system - equal (-13), with a marker, a combination of concomitant diseases - equal to (-1), with marker lack of concomitant diseases - equal (2); blood monocytes in the system, with a marker - no, set the PC to (0), with a 1-3% marker - (-2.5), with a 4-6% marker - (+2), with a 7-10 marker % - equal to (+2.5), with a marker of more than 10% - equal to (0); in the system, the erythrocyte sedimentation rate with a marker of 1-10 mm / h is set to PC equal to (-1), with a marker of 11-20 mm / h - equal to (-3), with a marker of 21-30 mm / h - equal to (+7 ), with a marker of 31-40 mm / h - equal to (0), with a marker of more than 40 mm / h - equal to (0); in the system, total bilirubin with a marker - less than 8.8 μmol / L is set to PC equal to (0), with a marker of 8.8-17 μmol / L - equal to (-1), with a marker over 17 μmol / L - equal to (+5 ,5); in the creatinine system, when the marker is less than 0.07 mmol / L, the PC is set to (+11), when the marker is 0.07-0.17 - equal to (-3), when the marker is more than 0.17 mmol / L - equal to (0 ); in the system, the specific gravity of urine with a marker less than -1008 sets the PC to (0), with a marker 1008-1026 - equal to (+2), with a marker of more than 1026 - equal to (+6); in the system, the urine reaction with the marker is acidic, set the PC to equal (+3), with the marker neutral - equal to (-3), with the alkaline marker - equal to (-12), with the amount of PC from (-54.5) to (- 21.5) predict a low probability of breast cancer, with a sum of (+11) to (+44.5) they predict a high probability of breast cancer.