磁共振功能参数对乳腺癌新辅助化疗疗效早期预测价值研究

Exploration of the value of magnetic resonance imaging in early prediction of tumor response to neoadjuvant chemotherapy in breast cancer

目的探索磁共振（MRI）功能成像对乳腺癌新辅助化疗（NAC）疗效的早期预测价值。方法回顾性分析2010年1月至2014年12月北京大学第一医院乳腺疾病中心接受NAC的151例乳腺癌病人资料。根据NAC前后组织病理学疗效评价分为病理显效组（GR）与病理非显效组（MR）；分析两组病人在NAC2周期后MRI肿瘤径线变化率（△D％）和功能成像参数表观扩散系数ADC值、最大线性斜率（Smax）的变化率（△ADC％、△Smax％）以及时间一信号强度曲线（TIC）类型变化（△TIC）与组织病理学疗效评价的关系；绘制△D％、△ADC％、△Smax％以及ATIC在2周期的变化与组织病理学疗效的曲线，计算ROC曲线下面积（AUC）。应用△ADC％、△Smax％建立NAC2周期后疗效预测模型logitP。结果NAC2周期前后2组△ADC％、△Smax％以及△TIC差异有统计学意义（P〈0．001）。△D％、△ADC％、△Smax％以及△TIC的AUC分别为0．600、0．820、0．807和0．786。logitP与组织病理学疗效的AUC为0．898（95％CI0．844—0．953）。结论以2周期MRI功能参数变化为基础的早期疗效预测模型对NAC疗效具有预测价值。

Objective To explore the value of functional parameters changes in the early prediction of tumor response to neoadju.vant chemotherapy. Methods A total of 151 cases of breast cancer received neoadjuvant chemotherapy and subsequent surgery at Peking University First Hospital from January 2010 to December 2014 were studied retrospectively. Breast MRI examinations were underwent to define the clinical response to the treatment. The enrolled cases were divided into good response （GR） group and minor response （MR） group, and the relationship of MRI parameters changes（ △D%, △ADC%, △Smax% and A TIC） and therapy response was analyzed. A clinical response prediction model logit P based on combined functional parameters was established, and AUCs for therapeutic effect prediction were compared to evaluate prediction efficacy. Result Functional parameters changes （△ADC%, △Smax%, △TIC） after 2 cycles of neoadjavant chemotherapy were significantly different between 2 groups（P〈0.001 ）.The AUCs for response prediction of △D%, △ADC%, △Smax% and ATIC were 0.600,0.820,0.807 and 0.786.The AUC for pathological prediction of logit P based on functional parameters was 0.898 （95% CI 0.844 -0.953）. Conclusion There is predictive value of functional parameters changes （△ADC%,△Smax% , △TIC） after 2 cycles of neoadjuvant therapy for pathologic response.