磁共振成像(MRI)及肿瘤分子标记物对乳腺癌新辅助化疗腋窝淋巴结疗效的评估与预测

A Study on the Evaluation and Predictive Value of Magnetic Resonance Imaging and Tumor Biomarkers for Axillary Lymphnode in Breast Cancer after Neoadjuvant Chemotherapy

目的探讨磁共振成像(MRI)及肿瘤分子标记物对乳腺癌新辅助化疗(NAC)腋窝淋巴结疗效的评估与预测价值。方法选择2015年1月至2020年12月首诊为局部进展期乳腺癌伴腋窝淋巴结转移的80例患者,患者NAC治疗后行手术切除及腋窝淋巴结清扫,根据NAC后腋窝淋巴结是否残留肿瘤细胞分为腋窝淋巴结病理完全缓解(pCR)与腋窝淋巴结非完全缓解(non-PCR)两组,将术前MRI及分子标记物表达情况与最终术后病理结果比较,评估术前MRI及分子标记物表达对腋窝淋巴结缓解的预测价值。结果两组间NAC前及NAC后最大淋巴结的表观扩散系数(ADC值)差异有统计学意义(P<0.05),ER阴性、PR阴性、Her2阳性与腋窝淋巴结pCR显著相关。多因素回归分析提示PR阴性、Her2阳性是腋窝淋巴结疗效的独立预测因子。结论肿瘤ADC值及分子标记物与乳腺癌新辅助化疗腋窝淋巴结疗效具有相关性,PR阴性、Her2阳性是腋窝淋巴结疗效的独立预测因子。

Objective To investigate the evaluation and predictive value of magnetic resonance imaging and tumor biomarkers for axillary lymphnode in breast cancer after neoadjuvant chemotherapy.Methods From January 2015 to December 2012,80 patients diagnosed as primary invasive breast cancer associated with axillary lymphnode metastasis,having received 4 cycles of neoadjuvant chemotherapy and finishing the surgery and axillary lymphnode dissection,entered this study.Subjects were divided into two groups on the basis of whether there are residual tumor cells in axillary lymphnodes after NAC:Pathologic complete response(pCR)or none pathologic complete response(non-pCR).The associations between MRI,tumor biomarkers and therapy response of axillary lymphnode as well as predictive value were analyzed.Results There were significant differences in ADC values of the largest lymph node before and after NAC between the two groups(P<0.05).ER-negative,PR-negative and HER2 positive were significantly correlated with pCR of axillary lymphnodes.Multivariate analysis showed that PR-negative and HER2 positive were independent factors for the pCR of axillary lymphnodes.Conclusion ADC values and tumor biomarkers were correlated with the pCR of axillary lymphnodes in breast cancer after NAC.PR-negative and HER2 positive were independent factors for the pCR of axillary lymphnodes.