DCE-MRI和免疫组化特征对乳腺癌患者新辅助化疗反应早期预测价值

Analysis of the Value of Predicting Response to Neoadjuvant Therapy in Breast Cancer Patients Based on DCE-MRI and Immunohistochemical Features

目的探讨基于DCE-MRI和免疫组化特征预测乳腺癌患者新辅助化疗(NAC)反应的应用价值。方法选取2018年5月至2023年5月于我院接受NAC的乳腺癌患者70例。所有患者于化疗前、化疗1疗程采取病理穿刺活检方式收集病理标本,采用免疫组化染色法测定乳腺癌组织雌激素受体(ER)、孕激素受体(PR)、人表皮生长因子受体2(HER-2)、Ki-67表达情况;同时分别在化疗前、化疗1疗程时采用DCE-MRI对患者病灶部位进行检查,收集定量指标(K_(ep)、V_(e)、K_(trans)、ADC值);根据患者化疗反应性分为组织学显著反应组(R组)和组织学非显著反应组(NR组);对比两组临床实验室资料,采用Logistic回归模型分析NAC低反应的影响因素,建立列线图模型并验证模型的效果;ROC曲线分析DCE-MRI和免疫组化指标在早期评估乳腺癌NAC治疗反应性的预测价值。结果经评估70例患者中有28例患者组织学显著反应(R组),42例患者组织学非显著反应(NR组);化疗前两组患者K_(ep)、V_(e)、K_(trans)、ADC值和ER、PR、HER-2、Ki-67阳性表达情况比较差异无统计学意义(均P>0.05);化疗1疗程后R组K_(ep)、V_(e)、K_(trans)值、Ki-67阳性表达率显著低于NR组,ADC值显著高于NR组(均P<0.05);多因素Logistic回归分析显示,K_(trans)(OR=142.871)、Ki-67阳性表达(OR=5.560)是乳腺癌患者NAC治疗低反应的独立危险因素,ADC值(OR=0.001)是乳腺癌患者NAC治疗低反应的独立保护因素(P<0.05);ROC曲线分析显示,三者联合预测NAC低反应的AUC为0.917,敏感度为85.71%、特异度为85.71%。结论动态对比增强MRI图像定量参数以及化疗后Ki-67表达状态用于早期评估乳腺癌新辅助化疗疗效的预测价值较高。

Objective To investigate the applied value of predicting response to neoadjuvant therapy in breast cancer patients based on DCE-MRI and immunohistochemical features.Methods 70 breast cancer patients who received NAC in our hospital from May 2018 to May 2023 were selected.All patients had pathological specimens collected before and after 1 course of chemotherapy.Immunohistochemical staining was employed to detect the expression of ER,PR,HER-2,and Ki-67 in breast cancer tissues.At the same time,DCE-MRI was used to examine the focus of patients before chemotherapy and during the first course of chemotherapy,and quantitative indexes(K_(ep),V_(e),K_(trans),ADC values)were collected.According to The patients′chemotherapy reactivity,the patients were divided into histologically significant response group(group R)and histologically insignificant response group(group NR).The clinical laboratory data of the two groups were compared,and the influencing factors of NAC low response were analyzed by Logistic regression model.A nomogram model was established,and the consistency of the model was verified using calibration curves.The predictive value of ROC curve analysis DCE-MRI and immunohistochemical indexes in early evaluation of NAC treatment responsiveness of breast cancer.Results Among 70 patients,28 patients(group R)showed significant histological reaction and 42 patients(group NR)showed no significant histological reaction;there were no statistical difference in K_(ep),V_(e),K_(trans),ADC values and positive expression of ER,PR,HER-2,Ki-67 between the two groups before chemotherapy(P>0.05);After one course of chemotherapy,the values of K_(ep),V_(e),K_(trans) and the positive expression rate of Ki-67 in group R were significantly lower than those in group NR,and the ADC values were significantly higher than those in group NR(all P<0.05).Multifactorial Logistic regression analysis showed that K trans(OR=142.871)and Ki-67 positive expression(OR=5.560)were independent risk factors for low response to NAC treatment in breast cancer patients.ADC value(OR=0.001)was an independent protective factor for low response to NAC treatment in breast cancer patients(P<0.05);ROC curve analysis showed that the AUC of the combination of the three predicted low response to NAC was 0.917 with a sensitivity of 85.71%and specificity of 85.71%.Conclusion The quantitative parameters of dynamic contrast-enhanced MRI images and Ki-67 expression status after chemotherapy have high predictive value for the early assessment of neoadjuvant chemotherapy efficacy in breast cancer.