局部进展期乳腺癌新辅助化疗早期ADC值变化与病理反应性的相关性

Correlation between apparent diffusion coefficient value and pathologic response of locally advanced breast cancer after neoadjuvant chemotherapy

目的探讨MR DWI早期ADC值变化对评估局部进展期乳腺癌新辅助化疗后疗效及预测肿瘤病理反应性的作用。方法回顾性分析103例局部进展期乳腺癌患者的MRI及临床资料。分别在化疗前、化疗2个周期及4个周期后测量肿瘤最小ADC值,按照病理反应性分级分为组织学显著反应组(MHR组)与组织学非显著反应组(NMHR组)。对两组化疗前后ADC值进行组间和组内比较,并比较两组化疗后ADC值变化率,用ROC曲线分析上述指标对评估病理反应性的效能。结果 MHR组51例,NMHR组52例。两组患者化疗前ADC值差异无统计学意义(P>0.05);MHR组化疗2个、4个周期后ADC值、ADC值变化率均高于NMHR组(P<0.05);化疗前后两组患者3次MRI测得最小ADC值均呈上升趋势,MHR组的变化值差异均有统计学意义(P<0.001),NMHR组化疗4个周期后ADC值较化疗前显著升高(P<0.001);2个、4个周期化疗后ADC值曲线下面积分别为0.68(P<0.01)、0.80(P<0.001),ADC值变化率曲线下面积分别为0.64(P<0.05)、0.72(P<0.001)。结论化疗前ADC值不能预测乳腺癌对新辅助化疗的病理反应性;化疗2个周期后ADC值及ADC值变化率可早期预测局部进展期乳腺癌病理反应性分级,以4个周期后ADC值及ADC值变化率的评估效能较高。

Objective To observe the value of apparent diffusion coefficient（ADC） value in evaluating the therapeutic effect of neoadjuvant chemotherapy（NAC） for locally advanced breast cancer（LABC） and predicting the pathologic response of pretreatment tumor.Methods MRI and clinical data of 103 patients with LABC were retrospectively analyzed.The minimum ADC value before NAC,after the 2nd and 4th cycle of NAC were measured.All the patients were divided into major histological response group（MHR group） and non-major histological response group（NMHR group） according to the final pathologic response.ADC value before and after NAC were compared within and between the two groups,and the variance rate of ADC values（ΔADC） were compared between the two groups.ROC curve analysis was performed to evaluate the effect of ADC value and ΔADC in predicting the pathologic response to the NAC treatment.Results Fifty-one patients with LABC were in MHR group,52 were in NMHR group.ADC values had no significant difference（P0.05） between the two groups before NAC.Both ADC value and ΔADC of MHR group were significantly higher than those of NMHR group after the 2nd and 4th cycle of NAC（P0.05）.ADC values of two groups showed upward trend in the 2nd and 4th cycle of NAC.Significant difference was found in MHR group（P0.001）,while ADC value of the 4th cycle of NAC was higher than that of before NAC in NMHR group.Area under ROC curve was 0.68（P0.01）,0.80（P0.001）,and area under ΔADC curve was 0.64（P0.05）,0.72（P0.001） in the 2nd and 4th cycle of NAC,respectively.Conclusion ADC value before NAC may not predict the pathological response of breast cancer,while ADC value and ΔADC of the 2nd cycle of NAC may be useful in predicting the early pathological response of breast cancer,while values after the 4th cycle would be more efficient.