乳腺MRI对保乳治疗后同侧乳腺肿瘤复发及复发后二次手术后远处转移的风险预测价值

Prediction value of breast MRI in ipsilateral breast tumor recurrence after breast-conserving surgery and distant metastasis following secondary surgery

目的:探讨常规磁共振成像(magnetic resonance imaging,MRI)特征对乳腺癌保乳治疗患者术后同侧乳腺肿瘤复发(ipsilateral breast tumor recurrence,IBTR)及其二次术后远处转移风险的预测价值。方法:回顾并分析2010年1月—2018年12月在复旦大学附属肿瘤医院接受保乳手术的6807例乳腺癌患者。其中67例发生IBTR并在本院完成术前MRI检查,按照年龄、临床分期、纤维腺体密度进行1∶2匹配,纳入134例无复发患者作为对照。单因素分析比较两组患者MRI特征及临床病理学资料,通过多因素logistic回归分析来明确可预测IBTR的独立因素。此外,在67例发生IBTR的患者中,筛选出47例接受了二次手术同时具有复发灶MRI图像的患者,中位随访时间为22.0个月(范围1.9~101.1个月),其中15例发生了远处转移,32例没有发生远处转移。通过单因素和多因素Cox回归分析确定与二次术后远处转移相关的独立预测因素。结果:单因素分析结果显示,病理学资料中的组织学分级、阴性切缘距离及分子分型,临床资料中有无术后辅助放疗以及术前MRI中的背景实质强化(background parenchymal enhancement,BPE)水平、病灶强化类型和病灶乳头及皮肤增厚凹陷均与术后IBTR相关(P<0.05);进一步多因素logistic回归分析提示,高BPE、非肿块病灶、乳头及皮肤增厚凹陷和分子分型为人表皮生长因子受体2(human epidermal growth factor receptor 2,HER2)+和三阴性乳腺癌,以及术后未接受放疗是发生IBTR的独立危险因素。此外,在47例接受了二次手术并具有复发灶MRI图像的患者中,单因素和多因素Cox回归分析显示,HER2-和术前MRI中的高BPE水平与二次术后远处转移的高风险相关。结论:术前MRI对辅助临床管理预保乳和IBTR患者有所裨益。术前MRI中的高BPE、非肿块病灶、乳头及皮肤增厚凹陷提示保乳术后局部复发的高风险,而复发灶MRI中的高BPE与二次术后远处转移的发生有关。

Objective:To examine the prognostic value of magnetic resonance imaging(MRI)characteristics for ipsilateral breast tumor recurrence(IBTR)patients following breast-conserving surgery(BCS)and the risk of distant metastasis following secondary surgery in patients with IBTR.Methods:A retrospective analysis was conducted on 6807 breast cancer patients who underwent BCS in Fudan University Shanghai Cancer Center between January 2010 and December 2018.Among them,67 cases experienced IBTR and underwent preoperative MRI examination at our institution.Using a 1∶2 ratio,they were matched with 134 control patients without recurrence based on age,clinical stage,and fibro glandular density.Univariate analysis was used to compare the MRI characteristics and clinical pathological data of the two groups.Multivariate logistic regression was performed to identify independent factors for IBTR.Furthermore,among the 67 patients with IBTR,47 patients underwent secondary surgery and had MR images of the recurrent tumor.The median follow-up time was 22.0 months(range from 1.9 to 101.1 months),with 15 cases developing distant metastasis and 32 cases without distant metastasis.Univariate and multivariate Cox regression analyses were conducted to determine independent predictive factors associated with distant metastasis following secondary surgery.Results:Univariate analysis revealed a significant association between histological grade,negative margin distance,molecular subtype,receipt of postoperative adjuvant radiotherapy,background parenchymal enhancement(BPE),lesion enhancement type,suspicion of involvement of the nipple skin on preoperative MRI,and postoperative IBTR(P<0.05).Additionally,multivariate logistic regression analysis demonstrated that high BPE,non-mass lesions,nipple or skin thickening with indentation,molecular subtypes of human epidermal growth factor receptor 2(HER2)+and triple-negative breast cancer,as well as not receiving radiotherapy after surgery,were independent risk factors for IBTR.Among the 47 patients who underwent secondary surgery and had MRI images of the recurrent tumor,univariate and multivariate Cox regression analysis indicated that negative HER2 status and high BPE levels on preoperative MRI were associated with a higher risk of distant metastasis after secondary surgery.Conclusion:Preoperative MRI provides valuable assistance in the auxiliary clinical management and prognostic prediction of patients undergoing breast-conserving surgery and experiencing IBTR.High BPE,non-mass lesions,and nipple or skin thickening with indentation on preoperative MRI indicate a high risk of local recurrence after breast-conserving surgery.In addition,high BPE on MRI of recurrent lesions is associated with the occurrence of distant metastasis after secondary surgery.