多模态超声联合血清基质金属蛋白酶9检测对乳腺癌保乳术后肿瘤复发的预测价值

To evaluate the predictive value of multimodal ultrasound combined with serum matrix metalloproteinase-9 in the recurrence of breast cancer after breast-conserving surgery

目的探究多模态超声特征联合血清基质金属蛋白酶9(matrix metalloproteinase-9,MMP-9)检测对乳腺癌保乳术后肿瘤复发的预测价值。方法选取2017年1月至2018年5月济宁医学院附属医院收治的194例行保乳手术治疗的乳腺癌患者,于术前行常规超声、自动乳腺全容积成像及超声造影检查,术后随访5年,根据肿瘤复发情况分为复发组和未复发组。应用Logistic回归方程分析影响乳腺癌保乳术后肿瘤局部复发的危险因素,绘制ROC曲线分析多模态超声特征联合血清MMP-9对乳腺癌保乳术后肿瘤局部复发的预测价值。结果术后随访5年,194例行保乳手术治疗的乳腺癌患者中有29例出现肿瘤局部复发、转移。两组肿瘤直径、毛刺征、汇聚征、Alder血流分级、增强顺序、模式及增强强度等比较,差异无统计学意义(t=1.48,P=1.451;χ^(2)=0.55,P=0.460;χ^(2)=0.50,P=0.478;χ^(2)=0.60,P=0.439;X=0.50,P=0.780;χ^(2)=0.04,P=0.981;χ^(2)=0.13,P=0.716)。Logistic回归分析结果显示,肿块形态不规则、出现微小钙化、周围放射状增强、存在灌注缺损、血清MMP-9异常升高是导致乳腺癌保乳术后肿瘤局部复发的独立危险因素(P=0.034,95%CI=1.177~62.266;P=0.048,95%CI=1.022~58.397;P=0.045,95%CI=1.100~56.756;P=0.043,95%CI=1.079~60.937;P=0.044,95%CI=1.000~1.026)。R0C曲线显示,多模态超声特征联合血清MMP-9预测乳腺癌保乳术后肿瘤局部复发的AUC为0.970,敏感度及特异度分别为98.63%和91.67%。结论多模态超声特征联合血清MMP-9检测在乳腺癌保乳术后肿瘤局部复发评估中具有较高的应用价值,为乳腺癌的临床诊治提供新思路。

Objective To explore the predictive value of multimodal ultrasound features combined with serum matrix metalloproteinase-9(MMP-9)detection for tumor recurrence of breast cancer after breast-conserving surgery.Methods A total of 194 patients with breast cancer who underwent breast-conserving surgery in Affiliat-ed Hospital of Jining Medical College from Jan.2017 to May.2018 were selected.Routine ultrasound,automated breast volume imaging and contrast-enhanced ultrasound were performed before surgery.Logistic regression equa-tion was used to analyze the risk factors affecting local tumor recurrence after breast-conserving surgery,and ROC curve was drawn to analyze the predictive value of multimodal ultrasound features combined with serum MMP-9 for local tumor recurrence after breast-conserving surgery.Results After 5 years of follow-up,29 out of 194 breast cancer patients who underwent breast-conserving surgery had local recurrence and metastasis.There were no signif-icant differences in tumor diameter,spiculation sign,convergence sign,Alder blood flow grade,enhancement se-quence,pattern and enhancement intensity between the two groups(P>0.05 t=1.48,P=1.451;χ^(2)=0.55,P=0.460;χ^(2)=0.50,P=0.478;χ^(2)=0.60,P=0.439;X=0.50,P=0.780;χ^(2)=0.04,P=0.981;χ^(2)=0.13,P=0.716).Logistic regression analysis showed that irregular tumor shape,small calcification,Peripheral radial enhancement,perfusion defect and abnormal elevation of serum MMP-9 were independent risk factors for local recurrence of breast cancer after breast-conserving surgery(P=0.034,95%CI=1.177~62.266;P=0.048,95%CI=1.022~58.397;P=0.045,95%CI=1.100~56.756;P=0.043,95%CI=1.079~60.937;P=0.044,95%CI=1.000~1.026).R0C curve showed that the AUC of multimodal ultrasound features combined with serum MMP-9 in predicting local tumor recurrence after breast-conserving surgery was 0.970,and the sensitivity and specificity were 98.63%and 91.67%,respectively.Conclusions Multimodal ultrasound features combined with serum MMP-9 detection have high application value in the evaluation of local tumor recurrence after breast-conserving surgery,and provide a new idea for the clinical diagnosis and treatment of breast cancer.