磁共振评估乳腺癌化疗联合靶向治疗在治疗期间对心脏结构和功能的影响

Effect of Chemotherapy Combined with Targeted Therapy on Cardiac Structure and Function in Breast Cancer Patients During Treatment Using Magnetic Resonance Imaging

目的使用MRI评估经化疗联合靶向治疗的乳腺癌患者心脏结构和功能的影像学改变。资料与方法纳入2020年7月—2021年10月于陆军军医大学西南医院经病理证实的50例乳腺癌化疗联合靶向治疗患者,在首次进行MRI检查患者中,9例尚未接受治疗,6例在蒽环类结束后,8例在靶向治疗6次后,21例在靶向治疗12次后,6例在靶向治疗超过12次后。50例患者中,2例接受5次检查,7例接受4次检查,10例接受3次检查,15例接受2次检查,其中16例在纳入检查1次后失访,共计114次MRI扫描,8次检查因图像质量欠佳或患者无法完成整个扫描而被剔除,共计106次MRI扫描。根据每次患者接受MRI检查所处药物治疗阶段分为紫杉醇、曲妥珠单抗和帕妥珠单抗组(TLHP组)和蒽环类、曲妥珠单抗和帕妥珠单抗组(EC-TH组),获得左心室射血分数(LVEF)、纵向应变、径向应变(GRS)、周向应变(GCS)等结构和功能学指标,并进行组间比较。结果TLHP组中,治疗前GRS和GCS分别为(31.80±4.58)%和(−18.75±1.81)%,治疗第6次显著下降[GRS:(25.40±6.87)%,P=0.049;GCS:(−16.00±2.67)%,P=0.033],全部17次靶向疗程结束仍未恢复到治疗前水平[GRS:(26.34±3.35)%,P=0.006;GCS:(16.71±1.42)%,P=0.011];LVEF由治疗前的(60.60±5.30)%显著下降到靶向治疗6次后的(54.42±5.03)%(P=0.042),全部靶向治疗结束后恢复到(61.39±6.52)%(P=0.039)。EC-TH组中,治疗前GRS和GCS分别为(31.80±4.58)%和(−18.75±1.81)%,治疗第6次显著下降[GRS:(26.33±5.46)%,P=0.025;GCS:(−16.64±2.32)%,P=0.028],然后逐渐恢复到治疗前水平;LVEF从蒽环类结束后的(62.57±4.11)%显著下降到靶向治疗6次的(57.26±4.88)%(P=0.016)。结论曲妥珠单抗和帕妥珠单抗治疗后,乳腺癌患者LVEF、GRS和GCS会在治疗期短暂下降,但在治疗结束后恢复,提示基于电影序列的心肌应变分析可以更敏感地反映乳腺癌患者靶向治疗对心肌的影响。

Purpose To evaluate the effect of chemotherapy combined with targeted therapy on cardiac structure and function in breast cancer patients during treatment using cardiac magnetic resonance imaging.Materials and Methods Fifty breast cancer patients received chemotherapy combined with targeted therapy in Southwest Hospital,Army Medical University from July 2020 to October 2021 and confirmed by pathology were enrolled.Of the patients who underwent the first MRI,nine cases had not yet received treatment,six cases after completion of anthracyclines,eight cases after 6 targeted therapies,21 cases after 12 targeted therapies,and six cases after more than 12 targeted therapies.Among 50 patients,two cases received 5 times examination,seven had experience 4 times examination,10 cases received 3 times examination,15 cases had received 2 times examination,including 16 patients lost to follow-up after into experience one time,a total of 114 MRI scans,8 times experience because of poor picture quality or patients to complete the whole scanning and eliminate,a total of 106 times.MRI data of patients were subdivided into subgroups of different treatment segments of Paclitaxel combined Trastuzumab and Pertuzumab group(TLHP group)and Anthracycline combined Trastuzumab and Pertuzumab group(EC-TH group)according to the drug treatment stage.The following structural and functional indexes of cardiac MRI were obtained and compared between the two groups:left ventricular ejection fraction(LVEF),global longitudinal strain,global radial strain(GRS),global circumferential strain(GCS).Results In TLHP group,GRS and GCS before the treatment were(31.80±4.58)%and(−18.75±1.81)%,respectively;and the 6th time of treatment decreased significantly[GRS:(25.40±6.87)%,P=0.049;GCS:(−16.00±2.67)%,P=0.033],all 17 targeted treatment did not return to the level before treatment[GRS:(26.34±3.35)%,P=0.006;GCS:(16.71±1.42)%,P=0.011];LVEF decreased significantly from(60.60±5.30)%before treatment to(54.42±5.03)%after 6 times of targeted therapy(P=0.042),and it was restored to all targeted therapy to(61.39±6.52)%after the end of the treatment(P=0.039).In the EC-TH group,the GRS and GCS before the treatment were(31.80±4.58)%and(−18.75±1.81)%,respectively;then significantly decreased after 6th time[GRS:(26.33±5.46)%,P=0.025;GCS:(−16.64±2.32)%,P=0.028],and then gradually returned to the level before treatment;LVEF significantly decreased from(62.57±4.11)%after Anthracycline to(57.26±4.88)%of 6th time(P=0.016).Conclusion LVEF,GRS and GCS of patients with breast cancer decreased briefly after treatment with Trastuzumab and Pertuzumab,but recovered after treatment,suggesting that myocardial strain analysis based on cine sequence can more sensitively reflect the effect of targeted therapy on myocardium in patients with breast cancer.