摘要
目的 探讨与乳腺癌新辅助治疗(neoadjuvant therapy, NAT)后肿瘤收缩模式相关的基线MRI特征及临床病理因素,并构建早期预测收缩模式的诺莫图。材料与方法 回顾性分析在我院确诊乳腺浸润性导管癌,并完成NAT和手术切除的连续性病例272例,随机分为训练组(190例)和验证组(82例)。根据NAT前后MRI上肿瘤形态和大小变化将收缩模式分为I类收缩(完全缓解、向心性收缩)和Ⅱ类收缩(非向心性收缩、疾病稳定及进展)。收集患者临床信息、肿瘤病理信息(分化程度、免疫组化分子分型等),以及基线MRI特征(包括强化方式、强化程度半定量参数等)。依次采用单因素、多因素逻辑回归分析寻找有效因素并建立预测模型,受试者工作特征曲线下面积(area under the curve, AUC)评价模型并筛选最佳模型构建诺莫图。结果 NAT后表现为I类收缩和Ⅱ类收缩的病例数分别为174例(占比64.0%)和98例(36.0%)。基线MRI强化方式和激素受体(hormone receptor, HR)与收缩模式独立相关,各自预测Ⅱ类收缩的AUC分别为0.844 [95%置信区间(confidence intervals,CI):0.784~0.892]和0.593(95%CI:0.519~0.663)。结合二者建立综合预测模型,AUC为0.890(95%CI:0.837~0.931),高于任意单一参数(P<0.05)。基于综合预测模型构建诺莫图,在验证组预测Ⅱ类收缩模式的AUC为0.871(95%CI:0.779~0.935),训练组与验证组的准确度分别为85.8%和82.9%。结论 MRI非单肿块强化和HR阳性是乳腺癌NAT后Ⅱ类收缩的独立危险因素。对强化方式和HR进行简单分析可为NAT降期保乳的可行性及效果提供合理预估,有利于临床制订合理的多学科治疗方案。
Objective:To select the baseline MRI features and clinicopathological factors that relate to tumor shrinkage patterns of breast cancers after neoadjuvant therapy(NAT),and construct a predicting nomogram.Materials and Methods:A total of 272 consecutive patients with breast invasive ductal carcinoma who underwent NAT and surgical resection in our hospital were retrospectively analyzed.The patients were randomly divided into training group(190 cases)and validation group(82 cases).According to the morphological changes of tumor on MRI before and after NAT,the shrinkage patterns were divided into type I shrinkage(complete response,concentric shrinkage)and typeⅡshrinkage(non-concentric shrinkage,stable and progressing disease).Baseline MRI features(size,enhancement mode,semi-quantitative parameters of enhancement,etc.)together with clinical and pathological information(degree of differentiation,immunohistochemical molecular type,etc.)were collected.Univariate and multivariate logistic regression analysis were used to select effective factors and to establish the predictive models.The area under the curve(AUC)was used to evaluate the diagnostic performance of the model and select the best one to construct a nomogram.Results:Type I andⅡshrinkage pattern were seen in 174(64.0%)and 98(36.0%)patients respectively.Baseline MRI enhancement mode and hormone receptor(HR)were independently correlated with shrinkage types with AUCs of 0.844[95%confidence intervals(CI):0.784-0.892]and 0.593(95%CI:0.519-0.663)respectively in predicting typeⅡshrinkage.A combined predictive model was established with AUC of 0.890(95%CI:0.837-0.931),higher than that of any single parameter(P<0.05)with accuracy of 85.8%,and a nomogram was constructed.The AUC and accuracy for predicting typeⅡshrinkage in the validation group was 0.871(95%CI:0.779-0.935)and 82.9%.Conclusions:Non single mass enhancement on MRI and positive HR are two independent risk factors for typeⅡshrinkage after NAT in breast cancer.A simple analysis of tumor enhancement mod
作者
罗瑶
曹崑
李晓婷
邓旭波
孙应实
LUO Yao;CAO Kun;LI Xiaoting;DENG Xubo;SUN Yingshi(Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education),Department of Radiology,Peking University Cancer Hospital&Institute,Beijing 100142,China)
出处
《磁共振成像》
CAS
CSCD
北大核心
2024年第1期35-42,共8页
Chinese Journal of Magnetic Resonance Imaging
基金
国家重点研发计划项目(编号:2023YFC3402805)
北京市医院管理中心“登峰”计划专项(编号:DFL20191103)
北京肿瘤医院院内基金项目(编号:XKFZ2403)。
关键词
乳腺癌
新辅助治疗
肿瘤收缩模式
诺莫图
磁共振成像
breast cancer
neoadjuvant therapy
tumor shrinkage pattern
nomogram
magnetic resonance imaging
