动态增强MRI定量参数与乳腺癌分子亚型的关系

Correlation of quantitative parameters of dynamic contrast-enhanced MRI with subtypes of breast carcinoma

目的探讨不同分子亚型乳腺癌动态对比增强MRI(DCE-MRI)定量参数及其与预后因子的关系。方法回顾性分析78例乳腺浸润性癌患者治疗前的MRI,测量定量参数Ktrans、Kep和Ve。测定免疫组化指标ER、PR和HER-2,并对分子亚型进行归类。比较不同分子亚型间及雌激素受体(ER)、孕激素受体(PR)、人类表皮生长因子受体(HER-2)不同表达状态时的DCE-MRI定量参数。结果最终68例入组,其中Luminal A型24例,Luminal B型19例,HER-2+型10例,三阴性乳腺癌(TNBC)15例。Kep值在不同分子亚型间差异有统计学意义(P<0.01)。Luminal A型和TNBC的Ktrans、Kep和Ve值的差异均有统计学意义(P均<0.05)。4个亚型中,TNBC的Ktrans和Kep值最大,Ve值最小。ER-者Kep值高于ER+者;PR-者Kep值亦高于PR+者,PR-者与PR+者Ktrans差异有统计学意义。结论通过Ktrans、Kep和Ve值可鉴别Luminal A型乳腺癌和TNBC;不同分子亚型及不同ER、PR表达状态的乳腺癌的Kep值不同。

Objective To explore the quantitative parameters on dynamic contrast-enhanced MRI（DCE-MRI） in patients with different subtypes of breast carcinoma,and to observe the correlation between the parameters and prognostic factors of breast cancers.Methods Totally 78 patients with pathologically proved infiltrating breast carcinoma who underwent DCE-MRI before treatment and quantitative parameters（Ktrans,Kep and Ve） were measured.Estrogen recepter（ER）,progesterone receptor（PR） and human epidermalgrowth factor receptor-2（HER-2） were obtained by immunohistochemistry,and then the subtype of every case was decided.The association between parameters and subtypes,as well as prognostic factors were analyzed.Results Among 68 available cases,24 were Luminal A,19 were Luminal B,10 were HER-2＋ and 15 were triple-negative breast cancer（TNBC）.Kep was significantly different among the four subtypes（P0.01）.Ktrans,Kep and Ve were significantly different between Luminal A and TNBC（all P0.05）.Among the four subtypes,TNBC had higher Ktrans and Kep and lower Ve.Kep was higher in tumors with ER-than ER＋,and Kep was also higher in tumors with PR-than PR＋.Ktrans was significantly different between PR-and PR＋.Conclusion The differentiation of Luminal A and TNBC by Ktrans,Kep and Ve is applicable.Kep is associated with subtypes of breast cancers and prognostic factors,including ER and PR.