多模态超声联合炎性细胞比值预测乳腺癌新辅助化疗疗效的应用价值

Value of multiparametric ultrasonography combined with inflammatory cell ratio in predicting the efficacy of neoadjuvant chemotherapy for breast cancer

目的探讨多模态超声特征联合外周血炎性细胞比值在乳腺癌新辅助化疗(NAC)疗效评估中的价值。方法回顾性选取2021年5月至2024年4月于安徽医科大学第二附属医院确诊并接受NAC治疗的乳腺癌患者106例,最终61例患者(61个肿块)纳入本研究。所有患者在接受NAC前和NAC治疗2周期后行多模态超声及外周血血常规检查,以组织学显著反应(MHR)和组织学非显著反应(NMHR)作为NAC疗效的评判和分组指标,比较MHR组与NMHR组NAC前及NAC治疗2周期后多模态超声特征及炎性细胞比值的差异,行二元多因素Logistic回归分析,确定乳腺癌NAC效果的独立预测因素,绘制ROC曲线,评估预测NAC疗效的诊断效能。结果在61个乳腺肿块中,MHR组25个(40.98%),NMHR组36个(59.02%)。二元多因素Logistic回归分析结果显示,第2周期后肿块最大径变化率(ΔD2)、第2周期后血管指数变化率(ΔVI2)、第2周期后弹性应变比变化率(ΔE-Strain2)、第2周期后反转成像评分变化率(ΔI-imaging score2)、NAC前血小板与淋巴细胞比值(PLR)是NAC疗效的独立预测因素(OR=1.145,P=0.019;OR=1.055,P=0.016;OR=1.036,P=0.033;OR=1.276,P=0.016;OR=1.054,P=0.047),上述参数联合诊断的ROC曲线下面积(AUC)为0.928(95%CI=0.866~0.990),敏感性为80.0%,特异性为91.7%。结论联合ΔD2、ΔVI2、ΔE-Strain2、ΔI-imaging score2及NAC前PLR对于早期预测乳腺癌NAC疗效有较高的临床应用价值。

Objective To investigate the value of multimodal ultrasound features combined with peripheral blood inflammatory cell ratios in evaluating the efficacy of neoadjuvant chemotherapy(NAC)in breast cancer.Methods A total of 106 breast cancer patients diagnosed and treated with NAC at the Second Affiliated Hospital of Anhui Medical University from May 2021 to April 2024 were retrospectively collected,resulting in the conclusion of 61 patients(61 masses)in the study.All patients underwent multimodal ultrasound and peripheral blood routine examinations before NAC and after two cycles of NAC treatment.The patients were divided into a major histological response(MHR)group and a non-major histological response(NMHR)group as indicators for evaluating NAC efficacy.The differences in multimodal ultrasound features and inflammatory cell ratios before NAC and after two cycles of NAC treatment between the MHR and NMHR groups were compared.Binary logistic multivariate regression analysis was performed to determine the independent predictors of NAC efficacy in breast cancer.ROC curves were plotted to evaluate the diagnostic efficacy of predicting NAC efficacy.Results Among the 61 breast masses,25(40.98%)were in the MHR group,and 36(59.02%)were in the NMHR group.Multivariate binary logistic regression analysis showed that the change rate of maximum tumor diameter after the second cycle(ΔD 2),change rate of vascular index after the second cycle(ΔVI 2),change rate of elastic strain ratio after the second cycle(ΔE-Strain 2),change rate of reverse imaging score after the second cycle(ΔI-imaging score 2),and platelet-to-lymphocyte ratio(PLR)before NAC were independent predictors of NAC efficacy(OR=1.145,P=0.019;OR=1.055,P=0.016;OR=1.036,P=0.033;OR=1.276,P=0.016;OR=1.054,P=0.047).The area under the ROC curve(AUC)for the combined diagnosis of the above parameters was 0.928(95%CI=0.866~0.990),with a sensitivity of 80.0%and a specificity of 91.7%.Conclusions The combination ofΔD 2,ΔVI 2,ΔE-Strain 2,ΔI-imaging score 2 and PLR before NAC has high clinical application value for early prediction of NAC efficacy in breast cancer.