摘要
目的探讨动态增强磁共振成像联合多层螺旋CT增强扫描对乳腺癌新辅助化学药物治疗(neoadjuvant chemotherapy,NACT)后疗效评估的预测价值。方法回顾性收集2019年2月至2021年8月期间在西南医科大学附属医院接受NACT的乳腺癌患者的临床、影像及病理资料,依据患者术后病理检测结果分为显著缓解(Miller-Payne分级疗效评价标准的Ⅰ~Ⅲ级)和非显著缓解(Miller-Payne分级疗效评价标准的Ⅳ~Ⅴ级),将单因素分析中有统计学意义的变量或基于专业知识判断可能有临床意义的因素纳入logistic回归多因素分析以筛选影响NACT后病理缓解程度的风险因素,再将筛选出的风险因素建立乳腺癌NACT后病理缓解程度的预测模型,并运用受试者操作特征曲线、校正曲线及临床决策分析曲线评价此模型的效能。结果根据纳入和排除标准,共收集到211例患者,其中术后病理检测结果为显著缓解者116例、非显著缓解者95例。logistic回归多因素分析结果显示,人表皮生长因子受体2阳性、NACT后的早期强化率越小、NACT后动脉期净增值越小、NACT后动脉期病灶CT值越小会增加NACT后乳腺癌患者显著缓解的概率(P<0.05),以这些因素构建的乳腺癌NACT后病理缓解程度预测模型的受试者操作特征曲线下面积为0.984,特异度为93.7%,敏感度为95.7%;校正曲线显示模型预测结果与实际结果拟合度高,决策曲线分析结果显示它有较高的临床净获益值。结论从本研究结果看,动态增强磁共振成像联合多层螺旋CT增强扫描结果对乳腺癌NACT后病理缓解程度有较好的预测价值,它可为进一步的治疗方案选择提供临床指导。
Objective To evaluate the predictive value of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)combined with multislice computed tomography(MSCT)in the evaluation of neoadjuvant chemotherapy(NACT)for breast cancer.Methods The clinical,imaging,and pathological data of breast cancer patients who received NACT in the Affiliated Hospital of Southwest Medical University from February 2019 to August 2021 were retrospectively collected.Based on the results of postoperative pathological examination,the patients were assigned into significant remission(Miller-Payne gradeⅠ–Ⅲ)and non-significant remission(Miller-Payne gradeⅣ–Ⅴ).The variables with statistical significance by univariate analysis or factors with clinical significance judged based on professional knowledge were included to conduct the logistic regression multivariate analysis to screen the risk factors affecting the degree of pathological remission after NACT.Then,the screened risk factors were used to establish a prediction model for the degree of pathological remission of breast cancer after NACT,and the efficacy of this model was evaluated using the receiver operating characteristic(ROC)curve,calibration curve,and decision curve analysis(DCA)curve.Results According to the inclusion and exclusion criteria,a total of 211 breast cancer patients who received NACT were collected,including 116 patients with significant remission and 95 patients with non-significant remission.Logistic regression multivariate analysis results showed that the human epidermal growth factor receptor 2 positive,lower early enhancement rate after NACT,lower arterial stage net increment after NACT,and lower CT value of arterial phase of lesions would increase the probability of significant remission in patients with breast cancer after NACT(P<0.05).The area under the ROC curve of the model for predicting the degree of pathological remission of breast cancer after NACT was 0.984,the specificity was 93.7%,and the sensitivity was 95.7%.The calibration curve showed tha
作者
陈进
胡美雪
权毅
CHEN Jin;HU Meixue;QUAN Yi(Sichuan Provincial Center for Gynaecology and Breast Surgery(Department of Breast Surgery),Affiliated Hospital of Southwest Medical University,Luzhou,Sichuan 646000,P.R.China)
出处
《中国普外基础与临床杂志》
CAS
2023年第1期65-71,共7页
Chinese Journal of Bases and Clinics In General Surgery
关键词
乳腺癌
动态增强磁共振成像
多层螺旋CT
新辅助化学药物治疗
病理缓解程度
breast cancer
dynamic contrast-enhanced magnetic resonance imaging
multislice computed tomography
neoadjuvant chemotherapy
pathological remission degree
