乳腺癌复发时间的临床病理因素及DCE-MRI预测价值研究

Predictive value of clinical and pathological features and DCE-MRI in breast cancer recurrence time

目的:分析乳腺癌患者的临床病理特征、DCE-MRI形态学表现及动态参数指标在预测患者复发时间中的价值。方法:回顾性分析2012年11月至2014年12月在我院就诊,经术后病理确诊并有术前乳腺MRI检查资料的乳腺癌患者,经过3年以上时间随访,依据病理证实或定期影像检查随访确诊为复发的患者58例,对比分析早期复发(术后≤2年)和晚期复发(术后> 2年)患者的临床病理和DCE-MRI特征。结果:在临床病理特征分析中,58例患者2年内乳腺癌术后复发率最高,平均复发时间为23个月(5～49个月),首发复发转移部位为骨转移多见。淋巴结转移数<4枚时多见于晚期复发组,≥4枚时多见于早期复发组,二者之间有统计学差异(P <0. 05); HER-2阳性多见于早期复发组,阴性多见于晚期复发组,二者之间有统计学差异(P <0. 05)。早期复发患者死亡率(39. 39%)高于晚期复发者(4. 00%),且二者具有统计学差异(P <0. 05)。在DCE-MRI特征中,早期复发组与晚期复发组间Vp_(max)值、MaxConc_(mean)值、AUC_(mean)值及MaxSlope_(mean)值存在差异,且差异具有统计学意义(P <0. 05)。结论:乳腺癌患者的淋巴结转移情况、免疫组化表型及DCE-MRI动态参数预测乳腺癌患者的复发时间有一定的价值。

Objective:To analyze the clinicopathological characteristics,DCE-MRI morphology and quantitative parameters of breast cancer patients for predicting the time of recurrence.Methods:Retrospectively analyzed the data of breast cancer patients who were diagnosed in our hospital from November 2012 to December 2014 by postoperative pathology.All patients had preoperative mammary MRI and were followed up for more than 3 years,fifty-eight patients with recurrence were confirmed by pathology or regular imaging examination.They were compared between clinicopathology and DCE-MRI characteristics in patients with early recurrence(postoperative≤2 years)and late recurrence(postoperative>2 years).Results:In the analysis of clinicopathologic features,58 patients had the highest recurrence rate of breast cancer within 2 years.The average recurrence time was 23 months(range 5~49 months).The first recurrence and metastasis site was more common in bone.Lymph node metastasis<4 was more common in the late recurrence group,and≥4 was more common in the early recurrence group.There was a statistically significant difference between the two groups(P<0.05).Positive HER-2 was more common in early recurrence group,and negative was more common in late recurrence group.There was a statistically significant difference between the two groups(P<0.05).In the DCE-MRI characteristics,there was a difference in Vp max,MaxConc mean,AUC mean,MaxSlope mean between the early recurrence group and the late recurrence group(P<0.05).Conclusion:Number of lymph node metastasis,immunohistochemical phenotype and DCE-MRI dynamic parameters of breast cancer patients have a certain value in predicting the recurrence time of breast cancer patients.