磁共振多征象分析对三阴性乳腺癌新辅助化疗病理完全缓解的预测价值

Predictive value of MR multi-sign analysis for pathological complete response of triple-negative breast cancer after neoadjuvant chemotherapy

目的探讨磁共振多征象分析对三阴性乳腺癌(TNBC)新辅助化疗病理完全缓解(p CR)的预测价值。方法对我院127例接受新辅助化疗的TNBC患者,依据化疗后的手术病理分为p CR组(19例)与非p CR组(108例),将两组患者常规MR、扩散加权成像(DWI)以及动态增强成像组合成磁共振成像诊断模型,比较两组患者磁共振各征象的差异;通过受试者工作曲线(ROC)评估该诊断模型的诊断效能,计算出相应的灵敏度、特异度以及曲线下面积(AUC);建立Logistic回归模型以分析磁共振多征象预测TNBC新辅助化疗p CR的独立因素。结果单因素分析结果显示,p CR组与非p CR组在肿瘤形态、瘤内T_2WI高信号、T_2WI瘤周水肿及ADC值变化率(ADC%)的差异均有统计学意义(P <0. 05)。非p CR组化疗前磁共振征象以形态不规则肿块为主,多存在瘤内T_2WI高信号以及T_2WI瘤周水肿征;非p CR组新辅助化疗前后的△ADC%为(28. 4±42. 5)%,低于p CR组的(57. 1±30. 2)%,差异有统计学意义(P=0. 005)。ROC曲线显示该诊断模型的灵敏度、特异度以及AUC分别为78. 9%、75. 0%以及0. 762; Logistic回归多因素分析结果显示,仅△ADC%是TNBC新辅助化疗p CR的预测因素(OR=3. 48,95%CI:1. 169～10. 364,P=0. 025)。结论磁共振多征象分析与TNBC新辅助化疗效果具有一定的相关性,有助于对化疗后p CR的预测。

Objective To investigate the predictive value of magnetic resonance(MR)multi-sign analysis in triple-negative breast cancer(TNBC)neoadjuvant chemotherapy with pathological complete response(pCR).Methods 127 patients with TNBC who received neoadjuvant chemotherapy were divided into pCR group(19 cases)and non-pCR group(108 cases)according to their postoperative pathology.The differences of magnetic resonance imaging signs between the two groups were compared.The diagnostic efficacy of the model was evaluated by receiver operating characteristic curve(ROC),and the sensitivity,specificity and area under the curve(AUC)were calculated.Logistic regression model was established to analyze the independent factors predicting pCR in neoadjuvant chemotherapy of TNBC with MR multi-sign.Results After neoadjuvant chemotherapy for TNBC,single factor analysis was performed between pCR group and non-pCRgroup.In non-pCR group,irregular mass,hyperintense intratumoral T 2WI and peritumoral edema were the main MRI signs before chemotherapy.The change rate of ADC value(△ADC%)before and after chemotherapy in non-pCR group was(28.4±42.5)%,lower than(57.1±30.2)%in pCR group(P<0.05).The ROC curve showed that the sensitivity,specificity and the AUC were 78.9%,75.0%and 0.762,respectively.Multivariate Logistic regression analysis showed that only△ADC%was the predictor of pCR in neoadjuvant chemotherapy of TNBC(OR=3.48,95%CI:1.169-10.364,P=0.025).Conclusion MR multi-sign analysis has a certain correlation with the effect of neoadjuvant chemotherapy for TNBC,which is helpful to predict pCR after chemotherapy.