动态增强磁共振成像定量参数对乳腺癌新辅助化疗疗效评价及相关性研究

The application value of dynamic contrast-enhanced magnetic resonance imaging quantitative parameters in the evaluation of the efficacy of neoadjuvant chemotherapy for breast cancer and its correlation with biological prognostic factors

目的:探讨动态增强磁共振成像(dynamic contrast-enhanced magnetic resonance imaging,DCE-MRI)定量参数及相关生物学因子的表达评估乳腺癌术前新辅助化疗疗效的应用价值。方法:回顾并收集临床资料完整且术前行新辅助化疗的女性乳腺癌患者56例,根据实体瘤疗效评价标准(Response Evaluation Criteria in Solid Tumor,RECIST)分为治疗有效和无效两组,比较两组化疗前、2个疗程后、化疗结束时的容量转移常数(Ktrans)、速率常数(Kep)、血浆容积分数(Ve值)。采用免疫组化染色法检测乳腺癌组织雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)、人表皮生长因子受体2(human epidermal growth factor receptor 2,HER2)及Ki-67表达情况,并分析不同表达状态时DCE-MRI定量参数的大小及DCE-MRI定量参数与Ki-67表达之间的相关性。结果:治疗有效组Ktransmax、Ktransmean、Kepmax、Kepmean值在2个疗程后及化疗结束时均明显低于治疗前(P<0.05),Ktransmin值在化疗结束时较治疗前明显降低(P<0.05)。ER、PR阴性组的Kepmax、Kepmean值高于ER、PR阳性组(P<0.05);PR阴性组的Vemax值高于PR阳性组(P<0.05)。Ki-67表达与Ktransmin、Ktransmax值及Ktransmean值呈正相关(r=0.384,P=0.003;r=0.294,P=0.028;r=0.551,P<0.01),Ki-67表达与Kep、Ve值无相关性(P>0.05)。结论:DCE-MRI定量参数及相关生物学因子的表达可对乳腺癌患者新辅助化疗疗效进行评估,值得临床推广应用。

Objective:To evaluate the value of dynamic contract-enhanced magnetic resonance imaging(DCE-MRI)quantitative parameters and the expression of related biological factors in the evaluation of the efficacy of neoadjuvant chemotherapy for breast cancer.Methods:A total of 56 female patients with breast cancer were recruited,all of them had complete clinical data and undertake neoadjuvant chemotherapy.In this study,they were divided into effective and ineffective groups according to the Response Evaluation Criteria in Solid Tumor(RECIST)criteria.The values of Ktrans,Kep and Ve before,after two courses and at the end of chemotherapy were compared.Immunohistochemical staining was used to detect the expression of estrogen receptor(ER),progesterone receptor(PR),human epidermal growth factor receptor 2(HER2)and Ki-67 in breast cancer tissues,and the size of DCE-MRI quantitative parameters in different expression states was analyzed.The correlation between the quantitative parameters of DCE-MRI and the expression of Ki-67 was analyzed.Results:The Ktransmax,Ktransmean,Kepmax,and Kepmean expression in the effective group were significantly decreased than those before neoadjuvant chemotherapy(P<0.05).The Ktransmin expression was significantly lower at the end of chemotherapy than before neoadjuvant chemotherapy(P<0.05).The Kepmax and Kepmean valus in the ER-expression and PR-expression negative groups were higher than those in the ER-expression and PR-expression positive groups(P<0.05).The Vemax value in the PR-negative group were higher than those in the PR-negative positive group(P<0.05).Ki-67 expression was positively correlated with Ktransmin,Ktransmax and Ktransmean values(r=0.384,P=0.003;r=0.294,P=0.028;r=0.551,P<0.01).There was no correlation between the value of Kep,Ve and Ki-67 expression(P>0.05).Conclusion:The quantitative parameters of DCEMRI and the expression of related biological factors can evaluate the efficacy of neoadjuvant chemotherapy in breast cancer patients,which is worthy of clinical application.