乳腺X线征象、ADC值联合血清CA125、CEA水平预测乳腺癌新辅助化疗后腋窝淋巴结病理状态的价值

Value of mammographic features,ADC value and serum CA125,CEA levels in predicting the pathological status of axillary lymph nodes after neoadjuvant chemotherapy in breast cancer

目的:探讨联合应用乳腺X线征象、磁共振表观扩散系数(ADC)值与血清CA125、CEA水平预测乳腺癌新辅助化疗后转移性腋窝淋巴结病理状态的价值。方法:前瞻性纳入2020年1月-2022年12月在我院接受全程新辅助化疗及腋窝淋巴结清扫术的152例女性乳腺癌患者作为研究对象,根据腋窝淋巴结清扫术后病理结果将所有患者分为腋窝病理完全缓解(PCR)组(55例)和非PCR组(97例)。于新辅助化疗前一周内,对所有患者进行乳腺X线和磁共振扩散加权成像检查及血清CA125、CEA水平检测。结果:乳腺癌新辅助化疗后腋窝PCR与非PCR患者的Ki-67表达状态差异有统计学意义(P<0.05)。新辅助化疗后腋窝非PCR患者治疗前乳腺X线征象中血管增多、增粗及边缘毛刺的发生比例显著高于PCR患者(P<0.05)。新辅助化疗后腋窝非PCR患者的治疗前ADC值显著低于PCR患者(t=4.372,P<0.001),而血清CA125、CEA水平显著高于PCR患者(P<0.05)。多因素Logistic回归分析结果显示,Ki-67高表达(X1)、血管增多、增粗(X2)、较高的ADC值(X4)、血清CA125水平(X5)是乳腺癌新辅助化疗后腋窝非PCR的独立危险因素(P<0.05),构建Logistic回归模型为Logit(P)=-3.206+0.792X1+0.953X2+1.199X4+0.845X5。ROC曲线分析结果显示,Logistic回归模型预测新辅助化疗后转移性腋窝淋巴结病理状态的曲线下面积为0.856(95%CI:0.794~0.917),敏感度和特异度分别为73.2%和85.5%。结论:乳腺X线特征、ADC值、血清CA125水平及Ki67表达状态与伴有转移性腋窝淋巴结的乳腺癌患者新辅助化疗后腋窝淋巴结病理状态有关,联合以上特征具有一定预测价值。

Objective:To investigate the value of combining mammographic features,apparent diffusion coefficient(ADC)value,and serum CA125,CEA levels in predicting the pathological status of metastatic axillary lymph nodes after neoadjuvant chemotherapy in breast cancer.Methods:A total of 152 female patients with breast cancer who received neoadjuvant chemotherapy and axillary lymph node dissection in our hospital from January 2020 to December 2022 were prospectively included.According to the pathological results after axillary lymph node dissection,all patients were divided into the axillary pathological complete response(PCR)group(55 cases)and the non-PCR group(97 cases).Within one week before neoadjuvant chemotherapy,all patients underwent mammography,diffusion-weighted magnetic resonance imaging,and serum CA125 and CEA level testing.Results:There were significant differences in Ki-67 expression between axillary PCR and non-PCR patients after neoadjuvant chemotherapy(P<0.05).The incidence of increased vascularity,thickened vessels,and spiculated margins in the mammographic findings of non-PCR axillary patients after neoadjuvant chemotherapy were significantly higher than that of PCR patients before treatment(P<0.05).After neoadjuvant chemotherapy,the ADC value in non-PCR patients was significantly lower than that of PCR patients before treatment(t=4.372,P<0.001),while serum CA125 and CEA levels were significantly higher than those of PCR patients(P<0.05).Multivariate logistic regression analysis showed that Ki-67 high expression(X1),increased vascularity and thickened vessels(X2),higher ADC value(X4),and serum CA125 level(X5)were independent risk factors for non-PCR after neoadjuvant chemotherapy in breast cancer patients(P<0.05).The constructed logistic regression model was as follows:Logit(P)=-3.206+0.792X1+0.953X2+1.199X4+0.845X5.ROC curve analysis showed that the area under the curve for predicting the pathological status of metastatic axillary lymph nodes after neoadjuvant chemotherapy was 0.856(95%CI:0.794~0.917),with a sensitivity and specificity of 73.2%and 85.5%,respectively.Conclusion:The mammogram features,ADC value,serum CA125 level,and Ki-67 expression status are associated with the pathological status of axillary lymph nodes after neoadjuvant chemotherapy in breast cancer patients with metastatic axillary lymph nodes,and the combination of these features has certain predictive value.