摘要
目的分析动态增强磁共振(DCE-MRI)预测乳腺癌新辅助化疗(NAC)治疗后病理完全缓解(pCR)的可行性。方法收集2018年8月到2022年12月本院收治的经NAC治疗乳腺癌患者120例,均在根治手术前行NAC治疗,术后以Miller&Payne改良病理反应标准评估患者治疗后pCR情况。对比化疗前后以及pCR组与未缓解组DCE-MRI定量参数值(K^(trans)、V_(e)、K_(ep));探究影响乳腺癌NAC治疗后病理完全缓解相关因素,通过绘制ROC曲线,分析DCE-MRI预测乳腺癌NAC治疗后pCR的效能。结果120例患者Miller&Payne分级显示,Ⅰ~Ⅲ级者86例(未缓解组),Ⅳ~Ⅴ级者34例(pCR组);NAC治疗后患者K^(trans)、V_(e)、K_(ep)值均明显低于NAC治疗前(P<0.05);pCR组K^(trans)、V_(e)、K_(ep)值均明显低于未缓解组(P<0.05);pCR组与未缓解组在年龄、肿瘤直径、生育情况、病理类型、NAC治疗方案、分子分型中比较,差异无统计学意义(P>0.05),pCR组TNM分期Ⅱ期占比高于未缓解组(88.24%vs 12.79%)(P<0.05);以组别(pCR组及未缓解组)为因变量,以TNM分期、K^(trans)、V_(e)、K_(ep)为自变量,进行Logistic回归分析结果显示:TNM分期[95%CI:(1.076~2.611)]、K^(trans)[95%CI:(1.120~1.678)]、V_(e)[95%CI:(1.253~2.479)]、K_(ep)[95%CI:(1.295~1.963)]为影响pCR的独立危险因素(P<0.01);ROC结果显示:K^(trans)+V_(e)+K_(ep)对pCR预测AUC值为0.879,高于K^(trans)、V_(e)、K_(ep)三者单独检测(P<0.05)。结论NAC治疗前后DCE-MRI定量参数K^(trans)、V_(e)、K_(ep)值存在明显变化,于NAC治疗后pCR患者中呈现更低水平;通过获取DCEMRI的影像数据,以预测NAC治疗后pCR的可行性高,有益于后续指导临床完善个体化治疗方案。
Objective To analyze the feasibility of dynamic contrast-enhanced magnetic resonance imaging(DCEMRI)in predicting pathological complete remission(pCR)after neoadjuvant chemotherapy(NAC)for breast cancer.Methods A total of 120 patients with breast cancer treated with NAC from August 2018 to December 2022 in our hospital were collected.All patients were treated with NAC before radical surgery.After surgery,the pCR status of patients after treatment was evaluated by Miller&Payne's modified pathological reaction standard.Compare the quantitative parameter values of DCE-MRI(K^(trans),V_(e),K_(ep))before and after chemotherapy,as well as between the pCR group and the unrelieved group;To explore the factors related to pathological complete remission after NAC treatment for breast cancer,and analyze the efficacy of DCE-MRI in predicting pCR after NAC treatment for breast cancer by drawing Receiver operating characteristic.Results The Miller&Payne grading of 120 patients showed that there were 86 cases of grade Ⅰ to Ⅲ(unrelieved group)and 34 cases of grade Ⅳ to Ⅴ(pCR group);The K^(trans),V_(e),and K_(ep) values of patients after NAC treatment were significantly lower than those before NAC treatment(P<0.05);The K^(trans),V_(e),and K_(ep) values of patients in the pCR group were significantly lower than those in the unrelieved group(P<0.05).There was no statistically significant difference between the pCR group and the unrelieved group in terms of age,tumor diameter,fertility status,pathological type,NAC treatment plan,and molecular typing(P>0.05),The proportion of patients with TNM stage II in the pCR group was higher than that in the unrelieved group(35.29%vs 12.79%)(P<0.05);Logistic regression analysis was conducted using pCR and non remission as dependent variables and TNM stage,K^(trans),V_(e),and K_(ep) as independent variables.The results showed that TNM stage[95%CI:(1.076-2.611)],K^(trans)[95%CI:(1.120-1.678)],V_(e)[95%CI:(1.253-2.479),and K_(ep) 95%CI(1.295-1.963)]were independent risk factors affecting pCR
作者
王巍巍
刘艳超
李颖
王琪
杨素君
Wang Wei-wei;LIU Yan-chao;LI Ying;WANG Qi;Yang Su-jun(CT Room,Handan Central Hospital,Handan 056008,Hebei Province,China;Department of Ultrasound,Handan Central Hospital,Handan 056008,Hebei Province,China)
出处
《中国CT和MRI杂志》
2024年第7期114-117,共4页
Chinese Journal of CT and MRI
基金
邯郸市科学技术研究与发展计划项目任务合同(1823208034ZC)。
关键词
动态增强磁共振
乳腺癌
新辅助化疗
病理完全缓解
Dynamic Enhanced Magnetic Resonance
Breast Cancer
Neoadjuvant Chemotherapy
Pathology in Complete Remission
