DCE-MRI定量参数K^(trans)、K_(ep)、V_(e)值与乳腺癌分子分型及预后的关系

Relationship between DCE-MRI quantitative parameters K^(trans),K_(ep),V_(e) values and molecular subtypes and prognosis in breast cancer

目的:探讨动态增强磁共振成像(dynamic enhanced magnetic resonance imaging,DCE-MRI)定量参数指标与乳腺癌分子分型及患者预后的关系。方法:选取河北省沧州市人民医院2020年4月至2022年11月收治的119例乳腺癌患者的临床资料。患者均进行DCE-MRI检查,整理患者容量转移常数(volume transfer constant,K^(trans))、血管外细胞外间隙容积比(extravascular extracellular interstitial volume ratio,V_(e))、速率常数(rate constant,K_(ep))测量值,比较不同分子分型的乳腺癌患者及孕激素受体(progesterone receptor,PR)、雌激素受体(estrogen receptor,ER)、表皮生长因子受体2(human epidermal growth factor receptor 2,HER-2)不同表达状态下的DCE-MRI定量参数值;采用Spearman分析不同DCE-MRI定量参数与ER、PR、HER-2阳性表达的相关性。结果:ER、PR阳性表达者K^(trans)、K_(ep)值均低于ER、PR阴性表达者(均P<0.05),ER、PR阳性与阴性表达者V_(e)值比较差异均无统计学意义(均P>0.05);HER-2阳性表达者V_(e)值高于阴性表达者(P<0.05),但K^(trans)、K_(ep)值在HER-2阳性与阴性表达者之间比较差异均无统计学意义(均P>0.05)。K^(trans)、K_(ep)与ER、PR阳性表达呈负相关(分别为r=-0.562、-0.592、-0.601、-0.592,均P<0.05),与HER-2阳性表达无明显相关性(分别为r=-0.163、-0.182,均P>0.05);V_(e)与HER-2阳性表达呈正相关(r=0.582,P<0.05),与ER、PR阳性表达无明显相关性(分别为r=0.156、0.106,均P>0.05)。不同分子分型DCE-MRI定量参数K^(trans)比较,从小到大分别为Luminal A型<Luminal B型<HER-2过表达型<三阴性乳腺癌(triple negative breast cancer,TNBC)型(均P<0.05);K_(ep)值比较,从小到大分别为Luminal A型<HER-2过表达型<Luminal B型<TNBC型(均P<0.05);V_(e)值比较,从小到大分别为TNBC型<Luminal A型<Luminal B型<HER-2过表达型(均P<0.05)。DCE-MRI对乳腺癌分子分型的诊断准确率为96.64%(115/119),与病理诊断结果具有良好的一致性(Kappa=0.966,P<0.05)。结论:DCE-MRI定量参数K^(trans)、K_(ep)、V_(e)值可作为乳腺癌分子分型及预后的有效参数,且与ER、PR、HER-2存在显著相关性。

Objective:To investigate the relationship between dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)quantitative parameters[volume transfer constant(K^(trans)),rate constant(K_(ep)),extravascular extracellular interstitial volume ratio(V_(e))]and molecular subtypes as well as prognosis in breast cancer patients.Methods:Clinical data from 119 breast cancer patients,who admitted to Cangzhou People’s Hospital from April 2020 to November 2022,were selected.All patients underwent DCE-MRI examination,and the measured values of Ktrans,Ve,K_(ep) were sorted out and compared among breast cancer patients with different molecular subtypes and different expressions of progesterone receptor(PR),estrogen receptor(ER)and human epidermal growth factor receptor 2(HER-2).Spearman analysis was used to investigate the correlation between different quantitative parameters of DCE-MRI and positive expressions of ER,PR,and HER-2.Results:Patients with positive expressions of ER and PR had lower Ktrans and K_(ep) values than those with negative expressions(all P<0.05).There was no significant difference in V_(e) values between ER and PR positive and negative expression(all P>0.05).Patients with HER-2 positive expression had higher V_(e) values than those with negative expression(P<0.05),but there was no significant difference in Ktrans and K_(ep) values between HER-2 positive and negative expression(both P>0.05).Ktrans and K_(ep) were negatively correlated with positive expressions of ER and PR(r=−0.562,−0.592,−0.601,−0.592,respectively,all P<0.05),but showed no significant correlation with HER-2 positive expression(r=−0.163,−0.182,respectively,both P>0.05).Ve was positively correlated with HER-2 positive expression(r=0.582,P<0.05),but had no significant correlation with positive expressions of ER and PR(r=0.156,0.106,respectively,both P>0.05).The comparison of Ktrans among different molecular subtypes of breast cancer was as follows:Luminal A<Luminal B<HER-2 overexpression<triple negative breast cancer(TNBC);the comparison of K_(ep) values was as follows:Luminal A<HER-2 overexpression<Luminal B<TNBC;the comparison of V_(e) values was as follows:TNBC<Luminal A<Luminal B<HER-2 over-expression(all P<0.05).The diagnostic accuracy of DCE-MRI for molecular subtypes of breast cancer was 96.64%(115/119),which was consistent with the results of pathological diagnosis(Kappa=0.966,P<0.05).Conclusion:The quantitative parameters of DCE-MRI(Ktrans,K_(ep),Ve)can be used as effective parameters for molecular subtyping and prognosis of breast cancer,and they are significantly correlated with ER,PR,and HER-2 expressions.