磁共振-弥散加权成像技术联合外周血IDO活性对乳腺癌患者新辅助化疗疗效的预测价值

Value of magnetic resonance diffusion-weighted imaging combined with peripheral blood IDO activity in the prediction of the curative effect of neoadjuvant chemotherapy for breast cancer

目的探讨磁共振(MR)-弥散加权成像(DWI)技术联合外周血吲哚胺2,3-双加氧酶(IDO)活性对乳腺癌患者新辅助化疗(NAC)疗效的预测价值。方法选择216例局部进展期乳腺癌患者,均进行手术治疗,且术前行NAC。NAC前后分别对患者进行MR-DWI检查,根据Miller&Payne改良病理反应性分级标准进行疗效评价。比较NAC前后组织学显著反应(MHR)组与非组织学显著反应(NMHR)组患者的表观扩散系数(ADC)、ADC变化率及外周血IDO活性。采用受试者工作特征(ROC)曲线分析ADC变化率、外周血IDO活性对乳腺癌患者NAC疗效的预测价值。结果216例患者中,MHR组72例,NMHR组144例。NAC前,MHR组和NMHR组患者的ADC值比较,差异无统计学意义(P﹥0.05);NAC后,MHR组患者的ADC值明显高于NMHR组患者,差异有统计学意义(P﹤0.01)。NAC前和NAC后,MHR组患者的ADC变化率明显高于NMHR组患者,差异有统计学意义(P﹤0.01)。ROC曲线分析结果显示,ADC变化率联合外周血IDO活性预测NAC疗效的曲线下面积为0.909(95%CI:0.791~1.019),高于ADC变化率单独预测的0.878(95%CI:0.754~1.001)和外周血IDO活性单独预测的0.802(95%CI:0.651~0.949),差异均有统计学意义(P﹤0.05)。结论MR-DWI联合外周血IDO活性对乳腺癌NAC的疗效具有较高的预测价值,可为临床治疗提供可靠指导。

Objective To investigate the value of magnetic resonance(MR)diffusion-weighted imaging(DWI)combined with peripheral blood indoleamine 2,3-dioxygenase(IDO)activity in the prediction of the curative effect of neoadjuvant chemotherapy(NAC)for breast cancer.Method A total of 216 patients with locally advanced breast cancer who underwent preoperative NAC followed by surgical management were enrolled in the study.All patients were examined by MR-DWI before and after NAC.The curative effect of chemotherapy was evaluated according to modified Miller&Payne grading system.The apparent diffusion coefficient(ADC),change rate of ADC,as well as peripheral blood IDO activity were assessed and compared between patients with major histological response(MHR)and those with non-major histological response(NMHR).The receiver operator characteristic(ROC)curve was plotted to determine the predictive value of change rate of ADC and peripheral blood IDO activity for the curative effect of NAC for breast cancer.Result Among the 216 cases with breast cancer,there were 72 patients in MHR group and 144 patients in NMHR group.Before NAC,the ADC values were similar between the two groups(P>0.05);while after NAC,the ADC values in MHR group were significantly higher than those in NMHR group(P<0.01),furthermore,the change rate of ADC before and after NAC was significantly higher in MHR group compared to NMHR group,the differences were of statistical significance(P<0.01).ROC curve analysis showed that the areas under the curve(AUC)of combined detection using ADC change rate and peripheral blood IDO activity for predicting the curative effect of NAC were 0.909(95%CI:0.791-1.019),and was higher than the 0.878(95%CI:0.754-1.001)or 0.802(95%CI:0.651-0.949)observed as ADC change rate or peripheral blood IDO activity used alone,respectively(P<0.05).Conclusion MR-DWI combined with peripheral blood IDO activity is of great value in predicting the curative effect of NAC for breast cancer,thereby offering meaningful guidance for clinical management.