超声定量参数早期预测乳腺癌新辅助化疗效果的价值

The value of ultrasound quantitative parameters in early evaluation of neoadjuvant chemotherapy for breast cancer

目的探讨超声定量参数早期对乳腺癌新辅助化疗(neoadjuvant chemotherapy,NAC)效果的预测价值。方法收集2018年3月至2020年10月于武汉大学人民医院行NAC后手术切除的乳腺癌患者,化疗前和第2个周期NAC后行多模态超声检查,测量的超声定量参数包括病灶最大径(diameter,D)、峰值强度(peak enhancement,PE)、达峰时间(time to peak,TTP)、剪切波速度最大值(maximum shear wave velocity,Vmax)和剪切波速度平均值(mean shear wave velocity,Vmean),计算相应参数的变化率(ΔD、ΔPE、ΔTTP、ΔVmax、ΔVmean)。根据Miller&Payne(MP)病理反应分级,将93例患者分为有效组(37例)和无效组(56例),比较两组间上述定量参数的差异,采用多因素Logistic回归分析对NAC反应有效的定量参数绘制ROC曲线,分析定量参数对NAC疗效的预测效能。结果93例患者化疗前,除年龄外,临床资料和病理特征两组间比较差异无统计学意义(P>0.05)。第2个周期NAC后,两组间ΔPE和ΔVmax差异有统计学意义(t=-3.417,P=0.001;Z=-5.173,P<0.001)。多因素Logistic回归分析示ΔPE和ΔVmax是评估NAC有效的预测因子(OR=1.105,95%CI=1.032~1.184,P=0.004;OR=1.232,95%CI=1.125~1.349,P<0.001)。ΔPE和ΔVmax预测NAC疗效的最佳截断值分别为16.37%和28.52%,ΔPE>16.37%、ΔVmax>28.52%提示NAC病理反应有效,ΔPE、ΔVmax和ΔPE+ΔVmax预测NAC疗效的敏感性和特异性分别为83.78%、57.14%,78.38%、85.71%,75.68%、91.07%。结论超声定量参数可早期预测乳腺癌NAC疗效,参数联合应用有助于提高预测效能。

Objective To investigate the predictive value of quantitative parameters of ultrasound on early neoadjuvant chemotherapy(NAC)in breast cancer.Methods Between March 2018 and October 2020,breast cancer patients who underwent surgery after NAC treatment in Renmin Hospital of Wuhan University were collected.Multimodal ultrasound examinations were performed before chemotherapy and after NAC in the second cycle.The quantitative parameters of ultrasound included diameter(D),peak enhancement(PE),time to peak(TTP),maximum shear wave velocity(Vmax)and mean shear wave velocity(Vmean).The change rates of corresponding parameters(ΔD,ΔPE,ΔTTP,ΔVmax,ΔVmean)were calculated.According to Miller&Payne(MP)pathological reaction classification,93 patients were divided into effective group(37 cases)and ineffective group(56 cases).The differences of quantitative parameters between the two groups were compared.Multivariate logistic regression was used to analyze the effective quantitative parameters of NAC response,and ROC curve was plotted to analyze the predictive effect of quantitative parameters on NAC efficacy.Results Before NAC,there were no significant differences in clinical data and pathological features between the two groups except age(all P>0.05).After the second cycle of chemotherapy,ΔPE andΔVmax were significantly correlated with the efficacy of NAC(t=-3.417,P=0.001;Z=-5.173,P<0.001).Multivariate regression analysis showedΔPE andΔVmax were effective predictors of NAC(OR=1.105,95%CI=1.032-1.184,P=0.004;OR=1.232,95%CI=1.125-1.349,P<0.001).The cutoff values ofΔPE andΔVmax in evaluating the efficacy of NAC were 16.37%and 28.52%.ΔPE>16.37%,andΔVmax>28.52%suggested the pathologically effective response of NAC.The sensitivity and specificity ofΔPE,ΔVmax andΔPE+ΔVmax were 83.78%,57.14%;78.38%,85.71%;75.68%,91.07%,respectively.Conclusions The quantitative ultrasound parameters have certain clinical value in early prediction of NAC efficacy of breast cancer,and the combined application of parameters can help to improve the prediction efficiency.