超声特征及免疫组化标志物对乳腺癌新辅助治疗后腋窝淋巴结病理完全缓解的预测价值

Predictive value of ultrasonographic features and immunohistochemical markers for pathological complete response of axillary lymph nodes after neoadjuvant therapy for breast cancer

目的探讨超声特征及免疫组化标志物对乳腺癌新辅助治疗(NAT)后腋窝淋巴结病理完全缓解(pCR)的预测价值。方法回顾性分析2020年1月~2023年9月南通市肿瘤医院收治的伴腋窝淋巴结转移(ALNM)的140例乳腺癌患者的临床资料,所有患者均接受NAT+手术切除+腋窝淋巴清扫。根据腋窝淋巴结病理结果将患者分为pCR组(n=53)和非pCR组(n=87),比较两组NAT前乳腺癌原发灶及腋窝淋巴结超声特征及免疫组化标志物,采用Logistic回归分析确立乳腺癌NAT后腋窝淋巴结pCR的独立预测因素,并采用ROC曲线验证其预测效能。结果两组原发灶纵横比、Adler血流分级,腋窝淋巴结短径、长短径比值、皮髓质分界、形态、彩色多普勒血流成像血流信号,HER-2及Ki-67的差异有统计学意义(P<0.05)。Logistic回归分析显示,腋窝淋巴结长短径比值≥2、腋窝淋巴结形态Ⅰ~Ⅱ型、腋窝淋巴结无彩色多普勒血流成像血流信号、HER-2阳性及Ki-67高表达是乳腺癌NAT后腋窝淋巴结p CR的独立预测因素(P<0.05)。ROC曲线显示,联合诊断的预测效能最高,曲线下面积为0.739(95%CI:0.643~0.812),敏感度为68.42%,特异度为75.34%。结论超声特征及免疫组化标志物对乳腺癌NAT后腋窝淋巴结pCR具有一定的预测价值。

Objective To investigate the predictive value of ultrasound features and immunohistochemical markers for axillary lymph node pathological complete response(pCR)after neoadjuvant therapy(NAT)for breast cancer.Methods The clinical data of 140 breast cancer patients with axillary lymph node metastasis(ALNM)admitted to Nantong Tumor Hospital from January 2020 to September 2023 were retrospectively analyzed.All patients underwent NAT+surgical resection+axillary lymph node dissection.According to the pathological results of axillary lymph nodes,the patients were divided into pCR group(n=53)and non-pCR group(n=87).The ultrasonic features and immunohistochemical markers of primary breast cancer and axillary lymph nodes before NAT were compared between the two groups.Logistic regression analysis was used to establish the independent predictors of pCR of axillary lymph nodes after NAT of breast cancer,and ROC curve was used to verify its predictive efficacy.Results There were significant differences in the aspect ratio of primary tumor,Adler blood flow grading,short diameter of axillary lymph nodes,ratio of long and short diameter,cortical and medullary boundary,morphology,CDFI blood flow signal,HER-2 and Ki-67 between the two groups(P<0.05).Logistic regression analysis showed that the ratio of long and short diameter of axillary lymph nodes≥2,axillary lymph node morphology type I-II,no CDFI blood flow signal in axillary lymph nodes,HER-2 positive and Ki-67 high expression were independent predictors of pCR of axillary lymph nodes after NAT in breast cancer(P<0.05).ROC curve showed that the combined diagnosis had the highest predictive efficiency,with AUC of 0.739(95%CI 0.643-0.812),sensitivity of 68.42%and specificity of 75.34%.Conclusion Ultrasound features and immunohistochemical markers have certain predictive value for pCR of axillary lymph nodes after NAT in breast cancer.