多模态超声特征与乳腺癌新辅助化疗患者术后病理缓解程度及BCL-2表达的相关性

Correlation between characteristics of multimodal ultrasound and postoperative pathological remission and expression of BCL-2 in breast cancer patients with neoadjuvant chemotherapy

目的探讨乳腺癌新辅助化疗(neoadjuvant chemotherapy,NAC)患者多模态超声特征与术后病理缓解程度及B淋巴细胞瘤-2(B-cell lymphoma-2,BCL-2)表达的相关性,为治疗方案的选择提供参考思路。方法选择2018年1月至2020年12月于陕西省中医医院采取NAC并进行保乳或全乳切除手术治疗的女性乳腺癌患者作为研究对象。于化疗后手术前进行常规超声、自动乳腺全容积成像和超声造影检查,参照Miller and Payne改良病理反应分级标准进行术后病理缓解程度评价,采用免疫组织化学法检测乳腺癌组织中的BCL-2表达水平。对MHR和NMHR组、BCL-2不同表达状态组间的多模态超声特征进行单因素分析,应用二元Logistic回归对单因素分析中有意义的变量进行多因素分析。结果在186例患者中,NAC患者术后MHR组84例(45.2%),NMHR组102例(54.8%),NMRH组的肿块最大径>4 cm、肿块形态不规则、出现微小钙化、CEUS出现高增强、灌注缺损的比例(分别为62.7%、62.7%、70.6%、62.7%、66.7%)显著高于MRH组(分别为38.1%、40.5%、39.3%、41.7%、31.0%)(P均<0.05);BCL-2低水平表达者出现肿块形态不规则、微小钙化、Alder血流分级2~3级、高增强和周围放射性增强的比例(分别为65.1%、69.8%、65.1%、71.7%、72.6%)显著高于BCL-2高表达者(分别为36.2%、38.7%、27.5%、28.7%、38.8%)(P均<0.05)。多因素Logistic分析结果表明,肿块形态不规则和出现微小钙化是术后NMHR的独立危险因素(P均<0.05);肿块形态不规则、伴微小钙化、CEUS表现为周围放射状增强是BCL-2低表达的独立危险因素(P均<0.05)。结论多模态超声特征可用于预测乳腺癌NAC患者术后病理缓解程度及BCL-2的表达状态,有助于选择治疗方案和预测患者预后。

Objective To explore the characteristics of multimodal ultrasound before neoadjuvant chemotherapy(NAC)and the degree of postoperative pathological remission and B-cell lymphoma-2(BCL-2).Methods From Jan.2018 to Dec.2020,female breast cancer patients who underwent breast-conserving or total mastectomy surgery at Shaanxi Hospital of traditional Chinese Medicine were selected as the research objects.Routine ultrasound,automatic breast full-volume imaging,and contrast-enhanced ultrasound were performed before chemotherapy.The postoperative pathological remission was evaluated according to Miller and Payne’s modified pathological response grading standard.The expression of BCL-2 in breast cancer tissue was detected by immunohistochemistry.Univariate analysis was performed on the characteristics of MHR,NMHR and bcl-2 with different expression status.Then,binary Logistic regression was used to analyze the significant variables in univariate analysis.Results Among 186 patients,84 patients(45.2%)were in MHR group and 102 patients(54.8%)in NMHR group after NAC surgery.The maximum diameter of mass in NMRH group was>4 cm.The proportion of CM,irregular shape of mass,microcalcification,high enhancement of CEUS and perfusion defect(62.7%,62.7%,70.6%,62.7%,66.7%)was significantly higher than that of MRH group(38.1%,40.5%,39.3%,41.7%,31.0%,P<0.05).The proportion of irregular shape,microcalcification,Alder blood flow grade 2-3,hyperenhancement and peripheral radiation enhancement in low bcl-2 expression patients(65.1%,69.8%,65.1%,71.7%,72.6%,respectively)was significantly higher than that in high Bcl-2 expression patients(36.2%,38.7%,27.5%,28.7%,38.8%respectively)(all P<0.05).Multivariate Logistic analysis showed that irregular masses,with microcalcifications,and high CEUS performance were independent risk factors for NMHR(all P<0.05);irregular masses,with microcalcifications,and CEUS manifestations of peripheral radial enhancement were independent risk factors for low expression of BCL-2(all P<0.05).Conclusion Multimodal ultrasound features can be used to predict the degree of pathological remission and the expression of BCL-2 in breast cancer patients with NAC,which helps to select treatment options and predict the prognosis of patients.