Establishment And Validation Of A Risk Scoring System For Early Stage Of Shoulder Joint Dysfunction After Breast Cancer Surgery

Objective The aim of this study is to establish a risk scoring system for early stage shoulder joint dysfunction after breast cancer surgery.It is to also verify its clinical application value.This may be used by clinical staff to screen breast cancer patients with early postoperative shoulder dysfunction in high-risk groups and to provide guidance and basis for early prevention.Methods This study is divided into two parts.The first part is a retrospective case-control study,using the inclusion criteria and exclusion criteria selected from September 2014 to December 2015 in 110 breast cancer surgery cases of.The patients were divided into experimental(early stage shoulder joint dysfunction,43 cases)and control(non-early stage shoulder joint dysfunction,67 cases),according to the shoulder joint range of motion(ROM)measurement standard.We collected four categories of information about patient,general information,treatment information,behavioral information,and social information.The data of the subjects were analyzed by single factor and multi-factor logistic regression(forward method).According to regression coefficients and/or values for variables in the logistic regression equation,a logistic-scoring system and additive-scoring system for predicting shoulder joint dysfunction in early stage after breast cancer surgery were established.The area under the receiver operating characteristic(ROC)curve(AUC)was used to evaluate the predictive power of logistic-scoring systems and additive-scoring systems.The second part is a prospective study.According to the inclusion criteria and exclusion criteria between January 2016 to June 2016,110 cases of breast inpatients was chosen.The risk score system constructed in this study was used to assess the risk score of the 110 subjects.We analyzed that the prediction and actual cases of early breast cancer postoperative shoulder joint dysfunction occur at a consistent level.We wanted to further evaluate the authenticity and reliability of the risk scoring system for early stage shoulder joint dysfunction after breast cancer surgery.Results ① Multi-factor logistic regression(forward method)indicated that family supervision,functional exercise frequency,time and pattern were risk factors for early stage shoulder joint dysfunction after breast cancer surgery.②According to the regression coefficient of each variable in the logistic regression equation and/or value,logistic-scoring systems and additive-scoring systems for predicting shoulder joint dysfunction in early stage after breast cancer surgery was established.Logistic and additive system scores were 0～85 and 3～22,respectively.③ The logistic system score of 52,sensitivity and specificity were optimal(74.42%and 92.54%,respectively),with an area under the ROC(AUC)of 0.891(95%CI:0.825～0.957).When the additive system score was 12.5,sensitivity and specificity were optimal(88.37%and 73.13%,respectively),with AUC of 0.849(95%CI:0.775～0.922).④46 patients with early stage shoulder dysfunction were predicted and 31 cases of early stage shoulder dysfunction was actualized.The difference was statistically significant(X2=4.496,P=0.034).Conclusion ① Multi-factor logistic regression(forward method)indicated that family supervision,functional exercise frequency,time and pattern were risk factors for early stage shoulder joint dysfunction after breast cancer surgery.②The established logistic-scoring systems and additive-scoring systems were used to determine the scores of high risk groups of early stage shoulder joint dysfunction,≥52 points and≥12.5 points,respectively.③In this study,a scientific method was used to verify the risk score system.The constructed risk scoring system for early stage shoulder joint dysfunction after breast cancer surgery has a good veracity and reliability.Using this study,guidance for the early prevention of early stage shoulder dysfunction after breast cancer surgery can be given.