Correlation and predictive value of pathological complete response and ultrasound characteristic parameters in neoadjuvant chemotherapy for breast

BACKGROUND Breast cancer ranks as one of the most prevalent malignant tumors among women,significantly endangering their health and lives.While radical surgery has been a pivotal method for halting disease progression,it alone is insufficient for enhancing the quality of life for patients.AIM To investigate the correlation between ultrasound characteristic parameters of breast cancer lesions and clinical efficacy in patients undergoing neoadjuvant chemotherapy(NAC).METHODS Employing a case-control study design,this research involved 178 breast cancer patients treated with NAC at our hospital from July 2019 to June 2022.According to the Miller-Payne grading system,the pathological response,i.e.efficacy,of the NAC in the initial breast lesion after NAC was evaluated.Of these,59 patients achieved a pathological complete response(PCR),while 119 did not(non-PCR group).Ultrasound characteristics prior to NAC were compared between these groups,and the association of various factors with NAC efficacy was analyzed using univariate and multivariate approaches.RESULTS In the PCR group,the incidence of posterior echo attenuation,lesion diameter≥2.0 cm,and Alder blood flow grade≥II were significantly lower compared to the non-PCR group(P<0.05).The area under the curve values for predicting NAC efficacy using posterior echo attenuation,lesion diameter,and Alder grade were 0.604,0.603,and 0.583,respectively.Also,rates of pathological stage II,lymph node metastasis,vascular invasion,and positive Ki-67 expression were significantly lower in the PCR group(P<0.05).Logistic regression analysis identified posterior echo attenuation,lesion diameter≥2.0 cm,Alder blood flow grade≥II,pathological stage III,vascular invasion,and positive Ki-67 expression as independent predictors of poor response to NAC in breast cancer patients(P<0.05).CONCLUSION While ultrasound characteristics such as posterior echo attenuation,lesion diameter≥2.0 cm,and Alder blood flow grade≥II exhibit limited predictive value for NAC efficacy,they are significantly associated with poor response to NAC in breast cancer patients.

Prediction of pathological complete response and prognosis in locally advanced rectal cancer

BACKGROUND Colorectal cancer is currently the third most common malignant tumor and the second leading cause of cancer-related death worldwide.Neoadjuvant chemoradiotherapy(nCRT)is standard for locally advanced rectal cancer(LARC).Except for pathological examination after resection,it is not known exactly whether LARC patients have achieved pathological complete response(pCR)before surgery.To date,there are no clear clinical indicators that can predict the efficacy of nCRT and patient outcomes.AIM To investigate the indicators that can predict pCR and long-term outcomes following nCRT in patients with LARC.METHODS Clinical data of 128 LARC patients admitted to our hospital between September 2013 and November 2022 were retrospectively analyzed.Patients were categorized into pCR and non-pCR groups.Univariate analysis(using the χ^(2) test or Fisher’s exact test)and logistic multivariate regression analysis were used to study clinical predictors affecting pCR.The 5-year disease-free survival(DFS)and overall survival(OS)rates were calculated using Kaplan-Meier analysis,and differences in survival curves were assessed with the log-rank test.RESULTS Univariate analysis showed that pretreatment carcinoembryonic antigen(CEA)level,lymphocyte-monocyte ratio(LMR),time interval between neoadjuvant therapy completion and total mesorectal excision,and tumor size were correlated with pCR.Multivariate results showed that CEA≤5 ng/mL(P=0.039),LMR>2.73(P=0.023),and time interval>10 wk(P=0.039)were independent predictors for pCR.Survival analysis demonstrated that patients in the pCR group had significantly higher 5-year DFS rates(94.7%vs 59.7%,P=0.002)and 5-year OS rates(95.8%vs 80.1%,P=0.019)compared to the non-pCR group.Tumor deposits(TDs)were significantly correlated with shorter DFS(P=0.002)and OS(P<0.001).CONCLUSION Pretreatment CEA,LMR,and time interval contribute to predicting nCRT efficacy in LARC patients.Achieving pCR demonstrates longer DFS and OS.TDs correlate with poor prognosis.

Tumor recurrence after pathological complete response in locally advanced gastric cancer after neoadjuvant therapy:Two case reports

BACKGROUND The pathological complete response(ypCR)rate following neoadjuvant chemotherapy for advanced gastric cancer remains low and lacks a universally accepted treatment protocol.Immunotherapy has achieved breakthrough progress.CASE SUMMARY We report two female patients with gastric cancer defined as clinical stage cT4N1-2M0.Detection of mismatch repair protein showed mismatch repair function defect,and perioperative treatment with programmed death protein 1 inhibitor combined with S-1+oxaliplatin achieved ypCR.Surprisingly,the patients underwent clinical observation after surgery but developed different degrees of metastasis at~6 mo after surgery.CONCLUSION PD-1 inhibitor combined with chemotherapy provides a more strategic choice for comprehensive perioperative treatment of gastric cancer.

Unfavorable Pathological Complete Response Rate of Neoadjuvant Chemotherapy Epirubicin plus Taxanes for Locally Advanced Triple-negative Breast Cancer

Anthracycline-Taxane chemotherapy is widely used in neoadjuvant treatment for breast cancers. However, there is limited data reported in patients with triple negative breast cancer （TNBC）. Here, we evaluated the pathologic responses and survival of neoadjuvant epirubicin and taxanes chemotherapy in patients with locally advanced TNBC to provide some useful information for clinical practice. A total of 43 patients with locally advanced TNBC were enrolled in this study. Patients were administered with epirubicin 75 mg/m^2 plus paclitaxel 175 mg/m^2 or docetaxel 75 mg/m^2 every 3 weeks for at least 2 cycles. The primary endpoint was pathologic complete response （pCR）, which was defined as no residual invasive cancer, or only carcinoma in situ in both the excised breast and axillary lymph node, while relapse-free survival （RFS） and overall survival （OS） were secondary endpoints. Thirty-nine （90.7%） patients were at clinical stages II B-IIIC. Thirty-seven （86%） completed 4-6 cycles of preop- erative chemotherapy, and objective response rate （ORR） was 81.4% （35/43）. Forty-two patients un- derwent radical surgery subsequently. The pCR rate was 14.3% （6/42）. The most common adverse events in neoadjuvant chemotherapy were nausea/vomiting （88.4%, 38/43） and neutropenia （88.4%）. After a median follow-up period of 34.0 months, 3-year RFS and OS rate was 53.6% and 80.1%, respectively. All events of recurrence and death occurred in non-pCR patients, in whom the 3-year RFS and OS rates were 44.3% and 76.6%, respectively. This study suggest that neoadjuvant chemotherapy with epirubicin plus taxanes has a relatively low pCR rate and high early recurrence risk in locally ad- vanced TNBC, which indicates the necessity for more efficacious treatment. Further study is needed to validate these results.

Nomogram for predicting pathological complete response to neoadjuvant chemotherapy in patients with advanced gastric cancer

BACKGROUND Survival benefit of neoadjuvant chemotherapy(NAC)for advanced gastric cancer(AGC)is a debatable issue.Studies have shown that the survival benefit of NAC is dependent on the pathological response to chemotherapy drugs.For those who achieve pathological complete response(pCR),NAC significantly prolonged prolapsed-free survival and overall survival.For those with poor response,NAC yielded no survival benefit,only toxicity and increased risk for tumor progression during chemotherapy,which may hinder surgical resection.Thus,predicting pCR to NAC is of great clinical significance and can help achieve individualized treatment in AGC patients.AIM To establish a nomogram for predicting pCR to NAC for AGC patients.METHODS Two-hundred and eight patients diagnosed with AGC who received NAC followed by resection surgery from March 2012 to July 2019 were enrolled in this study.Their clinical data were retrospectively analyzed by logistic regression analysis to determine the possible predictors for pCR.Based on these predictors,a nomogram model was developed and internally validated using the bootstrap method.RESULTS pCR was confirmed in 27 patients(27/208,13.0%).Multivariate logistic regression analysis showed that higher carcinoembryonic antigen level,lymphocyte ratio,lower monocyte count and tumor differentiation grade were associated with higher pCR.Concordance statistic of the established nomogram was 0.767.CONCLUSION A nomogram predicting pCR to NAC was established.Since this nomogram exhibited satisfactory predictive power despite utilizing easily available pretreatment parameters,it can be inferred that this nomogram is practical for the development of personalized treatment strategy for AGC patients.

Mismatch repair protein expression and intratumoral budding in rectal cancer are associated with an increased pathological complete response to preoperative chemoradiotherapy: A case-control study

AIM To determine whether the association of rectal adenocarcinoma with a defective-mismatch repair system(dMMR) was associated with a pathological complete response(pCR) to preoperative chemoradiotherapy.METHODS A case-control study was designed with the aim of determining if patients with rectal adenocarcinoma with dM MR had an associated high pCR rate in response to neoadjuvant chemoradiotherapy(nCRT).RESULTS Seventy-two cases with pCR were compared against 144 controls without pCR. Across 216 cases, the mean age was 56.8 years, 140(64.8%) were men, and 63(29.2%) demonstrated the dMMR system. The pCR was associated with G1 tumors, dMMR, the absence of vascular invasion, and low tumor budding in the pretreatment biopsy. In a multivariant analysis, the factors associated with pCR were dMMR(OR: 2.61; 95%CI: 1.355-5.040, P = 0.004) and a low degree of tumor budding(OR: 2.52; 95%CI: 1.366-4.894, P = 0.025).CONCLUSION We found an independent association between dMMR and a low rate of tumor budding, with a higher rate of pCR, in the basal biopsies of patients with rectal carcinoma subjected to nCRT.

Complete pathological response in locally advanced non-small-cell lung cancer patient: A case report

BACKGROUND Chemotherapy and radiotherapy followed by durvalumab is currently the standard treatment for locally advanced node-positive non-small-cell lung cancer(NSCLC).We describe the case of a patient with locally advanced node-positive NSCLC(LA-NSCLC)treated in a phase II prospective protocol with chemotherapy,accelerated hypofractionated radiotherapy(AHRT)and surgery in the preimmunotherapy era.CASE SUMMARY A 69-year-old male,ex-smoker(20 PY),with a Karnofsky performance status of 90,was diagnosed with locally advanced squamous cell lung carcinoma.He was staged by total body computed tomography(CT)scanning,and integrated 18Ffluorodeoxyglucose positron emission tomography/CT scan[cT4 cN3 cM0,stage IIIC according to TNM(tumor-node-metastasis)8th edition]and received AHRT between chemotherapy cycles,in accordance with the study protocol(EudractCT registration 2008-006525-14).At the end of the study the patient underwent surgery,which was not part of the protocol,and showed a complete pathological response.CONCLUSION This case report confirms that AHRT can be used successfully to treat primary LA-NSCLC with bilateral mediastinal lymph node involvement.Our case is of particular interest because of the pathological response after AHRT and the lack of surgical complications.We hypothesize that this radiotherapeutic approach,with its proven efficacy,could be delivered as a short course reducing treatment costs,increasing patient compliance and reducing toxicity.We are currently investigating the possibility of combining hypofractionation,chemotherapy and immunotherapy for patients with LA-NSCLC.

Pathological Complete Remission in Young Colon Cancer Patient with a Large Liver Metastasis after FOLFOX-4/Bevacizumab Treatment-A Case Report

Introduction. Pathological complete remission of liver metastases is a rare colon cancer treatment outcome with increased 5-year survival of 76%. Case report. Metastatic colorectal cancer patient with pathological complete remission of large hepatic metastasis after palliative chemotherapy in combination with bevacizumab is presented. Solitary liver metastasis measuring 8 cm was observed in computed tomography (CT) scan before combined treatment. The best radiological response during treatment with FOLFOX-4 and bevacizumab therapy was partial remission and patient underwent partial hepatectomy. Since the operation material was free of viable adenocarcinoma cells the effect of FOLFOX-4 in combination with bevacizumab treatment was interpreted as the pathological complete remission. Conclusion. Use of combination chemotherapy and targeted therapy with the aim to reduce initially unresectable liver metastasis is the best option to achieve complete pathological remission and significantly prolong survival.

Clinical parameters predicting pathologic complete response following neoadjuvant chemoradiotherapy for rectal cancer

Introduction:Preoperative chemoradiotherapy(CRT),followed by total mesorectal excision,has become the standard of care for patients with clinical stages II and III rectal cancer.Patients with pathologic complete response(pCR) to preoperative CRT have been reported to have better outcomes than those without pCR.However,the factors that predict the response to neoadjuvant CRT have not been well defined.In this study,we aimed to investigate the impact of clinical parameters on the development of pCR after neoadjuvant chemoradiation for rectal cancer.Methods:A total of 323 consecutive patients from a single institution who had clinical stage II or III rectal cancer and underwent a long-course neoadjuvant CRT,followed by curative surgery,between 2005 and 2013 were included.Patients were divided into two groups according to their responses to neoadjuvant therapy:the pCR and non-pCR groups.The clinical parameters were analyzed by univariate and multivariate analyses,with pCR as the dependent variable.Results:Of the 323 patients,75(23.2%) achieved pCR.The two groups were comparable in terms of age,sex,body mass index,tumor stage,tumor location,tumor differentiation,radiation dose,and chemotherapy regimen.On multivariate analysis,a pretreatment carcinoembryonic antigen(CEA) level of <5 ng/mL[odds ratio(OR) = 2.170,95%confidence interval(CI) = 1.195-3.939,P = 0.011]and an interval of >7 weeks between the completion of chemoradiation and surgical resection(OR = 2.588,95%CI = 1.484-4.512,P = 0.001) were significantly associated with an increased rate of pCR.Conclusions:The pretreatment CEA level and neoadjuvant chemoradiotherapy-surgery interval were independent clinical predictors for achieving pCR.These results may help clinicians predict the prognosis of patients and develop adaptive treatment strategies.

Potential predictive factors for pathologic complete response after the neoadjuvant treatment of rectal adenocarcinoma:a single center experience

Objective:To assess the response rate of patients with rectal adenocarcinoma to neoadjuvant therapy and to identify the predictors of histological regression after neoadjuvant radiotherapy(RT)or concurrent chemoradiotherapy(CCRT).Methods:This study recruited 64 patients.The patients had resectable cancer of the lower and the middle rectum(T3/T4 and/or N+)without distant metastasis and received neoadjuvant RT or CCRT followed by radical surgery with total mesorectal excision(TME)between January 2006 and December 2011.The patients were classified into non-response(NR),partial response(PR),and pathologic complete response(p CR)based on the Dworak tumor regression grading system.Results:The median age of patients was 57 years(ranging from 22 to 85).A total of 24 patients were treated with neoadjuvant CCRT,whereas 40 patients were treated with RT alone.Abdominoperineal resection(APR)was performed on 29 patients(45%).Anterior resection with TME was performed on 34 patients(53%).One patient had local resection.Histologically,12(19%),24(73%),and 28(44%)patients exhibited p CR,PR,and NR,respectively.Univariate analysis revealed that the predictors of tumor regression were as follows:the absence of lymph node involvement from initial imaging(c N0)(P=0.021);normal initial carcinoembryonic antigen(CEA)level(P=0.01);hemoglobin level≥12 g/dl(P=0.009);CCRT(P=0.021);and tumor downstaging in imaging(P=0.001).Multivariate analysis showed that the main predictors of p CR were CT combined with neoadjuvant RT,c N0stage,and tumor regression on imaging.Conclusions:Identifying the predictors of p CR following neoadjuvant therapy aids the selection of responsive patients for nonaggressive surgical treatment and possible surveillance.

Predictors of pathologic complete response in patients with residual flat mucosal lesions after neoadjuvant chemoradiotherapy for locally advanced rectal cancer

Objective:The accurate prediction of tumor response to neoadjuvant chemoradiotherapy(nCRT)remains challenging.Few studies have investigated pathologic complete response(ypCR)prediction in patients with residual flat mucosal lesions after treatment.This study aimed to identify variables for predicting ypCR in patients with residual flat mucosal lesions after nCRT for locally advanced rectal cancer(LARC).Methods:Data of patients with residual flat mucosal lesions after nCRT who underwent radical resection between 2009 and 2015 were retrospectively collected from the LARC database at Peking University Cancer Hospital.Univariate and multivariate analyses of the association between clinicopathological factors and ypCR were performed,and a nomogram was constructed by incorporating the significant predictors.Results:Of the 246 patients with residual flat mucosal lesions included in the final analysis,56(22.8%)had ypCR.Univariate and multivariate analyses showed that pretreatment cT stage(pre-cT)≤T2(P=0.016),magnetic resonance tumor regression grade(MR-TRG)1-3(P=0.001)and residual mucosal lesion depth=0 mm(P<0.001)were associated with a higher rate of ypCR.A nomogram was developed with a concordance index(C-index)of0.759 and the calibration curve showed that the nomogram model had good predictive consistency.The follow-up time ranged from 3.0 to 113.3 months,with a median follow-up time of 63.77 months.The multivariate Cox regression model showed that the four variables in the nomogram model were not risk factors for disease-free survival(DFS)or overall survival(OS).Conclusions:Completely flat mucosa,early cT stage and good MR-TRG were predictive factors for ypCR instead of DFS or OS in patients with LARC with residual flat mucosal lesions after nCRT.Endoscopic mucosal re-evaluation before surgery is important,as it may contribute to decision-making and facilitate nonoperative management or organ preservation.

Pathologic complete response confirmed by surgical resection for liver metastases of gastrointestinal stromal tumor after treatment with imatinib mesylate

A 39-year-old male underwent distal gastrectomy for a high grade gastrointestinal stromal tumor(GIST) . Computed tomography(CT) and magnetic resonance imaging(MRI) 107 mo after the operation,revealed a cystic mass(14 cm in diameter) and a solid mass(9 cm in diameter) in the right and left lobes of the liver,respectively. A biopsy specimen of the solid mass showed a liver metastasis of GIST. The patient received imatinib mesylate(IM) treatment,400 mg/day orally. Following the IM treatment for a period of 35 mo,the patient underwent partial hepatectomy(S4 + S5) . The effect of IM on the metastatic lesions was interpreted as pathologic complete response(CR) . Pathologically verified cases showing therapeutic efficacy of IM have been rarely reported.

Nomograms for predicting pathological response to neoadjuvant treatments in patients with rectal cancer

BACKGROUND In recent decades, neoadjuvant therapy(NT) has been the standardized treatment for locally advanced rectal cancer(LARC). Approximately 8%-35% of patients with LARC who received NT were reported to have achieved a complete pathological response(pCR). If the pathological response(PR) can be accurately predicted, these patients may not need surgery. In addition, no response after NT implies that the tumor is destructive, resistant to both chemotherapy and radiotherapy, and prone to having a high metastatic potential. Therefore,developing accurate models to predict PR has great clinical significance and can help achieve individualized treatment in LARC patients.AIM To establish nomograms for predicting PR to different NT regimens based on pretreatment parameters for patients with LARC.METHODS Rectal cancer patients were identified from the database of The Sixth Affiliated Hospital, Sun Yat-sen University from January 2012 to December 2016. Logistic regression and nomograms were developed to predict the probability of pCR and good downstaging to ypT0-2N0M0(ypTNM 0-I), respectively, based on pretreatment parameters for all LARC patients. Nomograms were also developed for three NT regimens(capecitabine/deGramont-RT, mFOLFOX6, and m FOLFOX6-RT) to predict pCR probability.RESULTS Four hundred and three patients were included in this study; 72(17.9%) had pCR at the final pathology report, and 177(43.9%) achieved good downstaging to ypT0-2N0M0(ypTNM 0-I). The nomogram for predicting pCR probability showed that NT regimens, tumor differentiation, mesorectal fascia(MRF) status,and tumor length significantly influenced pCR probability. When predicting the probability of good downstaging, tumor differentiation, MRF status, and clinical T stage were the significant factors. Nomograms were developed based on NT regimens. For the capecitabine/de Gramont-RT group, the multivariate analysis showed that the neutrophil-lymphocyte ratio(NLR) was the only significant factor, thus we could not develop a nomogram for this regimen. For the m FOLFOX6-RT group, the analysis showed that the significant factors were tumor length and MRF status; and for the mFOLFOX6 group, the significant factors were tumor length and tumor differentiation.CONCLUSION We established accurate nomograms for predicting the PR to preoperative NT regimens based on pretreatment parameters for LARC patients.

Clinicopathological predictors of long-term benefit in breast cancer treated with neoadjuvant chemotherapy

AIM To investigate the survival impact of clinicopathological factors, including pathological complete response(p CR) and tumor-infiltrating lymphocytes(s TIL) levels according to subtypes, in breast cancer(BC) patients who received neo-adjuvant chemotherapy(NAC).METHODS We evaluated 435 BC patients who presented and received NAC at the Instituto Nacional de Enfermedades Neoplasicas from 2003 to 2014. s TIL was analyzed as the proportion of tumor stroma occupied by lymphocytes, and was prospectively evaluated on hematoxylin and eosin-stained sections of the preN AC core biopsy. p CR was considered in the absence of infiltrating cancer cells in primary tumor and axillary lymph nodes. Analysis of statistical association between clinical pathological features, s TIL, p CR and survival were carried out using SPSSvs19.RESULTS Median age was 49 years(range 24-84 years) and the most frequent clinical stage was ⅢB(58.3%). Luminal A, Luminal B, HER2-enriched and(triple-negative) TN phenotype was found in 24.6%, 37.9%, 17.7% and 19.8%, respectively. p CR was observed in 11% and median percentage of s TIL was 40%(2%-95%) in the whole population. p CR was associated to Ct1-2(P = 0.045) and to high s TIL(P = 0.029) in the whole population. There was a slight trend towards significance for s TIL(P = 0.054) in Luminal A. s TIL was associated with grade Ⅲ(P < 0.001), no-Luminal A subtype(P < 0.001), RE-negative(P < 0.001), PgR-negative(P < 0.001), HER2-positive(P = 0.002) and p CR(P = 0.029) in the whole population. Longer disease-free survival was associated with grade Ⅰ-Ⅱ(P = 0.006), cN 0(P < 0.001), clinical stage Ⅱ(P = 0.004), ER-positive(P < 0.001), Pg R-positive(P < 0.001), luminal A(P < 0.001) and p CR(P = 0.002). Longer disease-free survival was associated with grade Ⅰ-Ⅱ in Luminal A(P < 0.001), N0-1 in Luminal A(P = 0.045) and TNBC(P = 0.01), clinical stage Ⅱ in Luminal A(P = 0.003) and TNBC(P = 0.038), and pC R in TNBC(P < 0.001). Longer overall survival was associated with grade Ⅰ-Ⅱ(P < 0.001), ER-positive(P < 0.001), PgR-positive(P < 0.001), Luminal A(P < 0.001), cN 0(P = 0.002) and p CR(P = 0.002) in the whole population. Overall survival was associated with clinical stage Ⅱ(P = 0.017) in Luminal A, older age(P = 0.042) in Luminal B, and pC R in TNBC(P = 0.005).CONCLUSION Predictive and prognostic values of clinicopathological features, like p CR and s TIL, differ depending on the evaluated molecular subtype.

外周血清学指标与乳腺癌新辅助化疗疗效相关性研究

目的 探讨外周血清学指标对乳腺癌新辅助化疗(NAC)疗效的预测价值。方法 根据是否达到病理完全缓解(pCR)分为pCR组、非pCR组,将收集指标与NAC疗效的相关性进行分析。结果 不同亚型乳腺癌患者接受NAC后的pCR率具有差异性,影响三阴性乳腺癌NAC后pCR率的标志物有12个;影响Luminal B型[人表皮生长因子受体2(HER2)阳性]乳腺癌NAC后pCR率的标志物有14个;影响Luminal B型(HER2阴性)乳腺癌NAC后pCR率的标志物有2个;HER2阳性、Luminal A型乳腺癌中均未发现影响NAC后达到pCR的血清学标志物。结论 不同亚型乳腺癌NAC后达到的pCR率有显著差异,预测不同亚型乳腺癌NAC后达到pCR的血清学标志物各异。

多模态超声对浸润性乳腺癌新辅助化疗后腋窝淋巴结病理完全缓解的预测价值

目的探讨多模态超声对浸润性乳腺癌患者新辅助化疗(NAC)后转移性腋窝淋巴结病理完全缓解(pCR)的预测价值。方法选取行腋窝淋巴结常规超声、经皮超声造影(pCEUS)和剪切波弹性成像(SWE)检查的NAC前临床N 1期乳腺癌患者148例,其中训练集112例,测试集36例。以腋窝淋巴结清扫术后病理结果为“金标准”,分为腋窝淋巴结pCR组和腋窝淋巴结病理未完全缓解(npCR)组,比较2组乳腺癌患者原发灶T分期、分子分型、腋窝淋巴结短径、长径/短径比、淋巴门结构、实质厚度、实质回声、边界、彩色多普勒超声(CDFI)血流类型、淋巴结造影增强模式、淋巴管连续性、淋巴结平均弹性模量(E mean)、最大弹性模量(E_(max))、最小弹性模量(E _(min))、标准差(SD)和弹性模量比值比(E _(ratio))等相关因素的差异,筛选出与腋窝淋巴结pCR相关的独立影响因素,构建logistic回归模型。在测试集中采用受试者工作特征(ROC)曲线、Hosmer-Lemeshow拟合优度检验、校准曲线和决策曲线综合评价模型的预测性能。结果训练集112例患者中,腋窝淋巴结pCR组49例,npCR组63例。单因素分析结果提示,腋窝淋巴结pCR组与npCR组的乳腺癌分子分型、淋巴结门结构、实质厚度、E mean、E_(max)、E _(min)、SD、E _(ratio)、造影增强类型和淋巴管连续性比较,差别有统计学意义(P<0.05)。多因素分析结果提示,乳腺癌HER2+型、淋巴结实质厚度≤0.38 cm、E_(max)<10.0 kPa、造影呈均匀/环形增强为腋窝淋巴结pCR的保护因素(P<0.05)。以多模态超声指标构建腋窝淋巴结pCR回归模型,预测模型的曲线下面积为0.831(95%CI:0.749~0.923,P<0.05),灵敏度为87.8%,特异度为70.9%。Hosmer-Lemeshow拟合优度检验、校准曲线和决策曲线结果表明,该预测模型在准确性、区分度、校准度和临床获益各方面的性能较好。结论多模态超声可有效识别NAC后腋窝淋巴结pCR病例,为临床N 1期乳腺癌患者NAC后腋窝淋巴结手术方式的选择提供影像学依据。

DCE-MRI预测乳腺癌NAC治疗后病理完全缓解的可行性研究

目的分析动态增强磁共振(DCE-MRI)预测乳腺癌新辅助化疗(NAC)治疗后病理完全缓解(pCR)的可行性。方法收集2018年8月到2022年12月本院收治的经NAC治疗乳腺癌患者120例,均在根治手术前行NAC治疗,术后以Miller&Payne改良病理反应标准评估患者治疗后pCR情况。对比化疗前后以及pCR组与未缓解组DCE-MRI定量参数值(Ktrans、Ve、Kep);探究影响乳腺癌NAC治疗后病理完全缓解相关因素,通过绘制ROC曲线,分析DCE-MRI预测乳腺癌NAC治疗后pCR的效能。结果120例患者Miller&Payne分级显示,Ⅰ~Ⅲ级者86例(未缓解组),IV~V级者34例(pCR组);NAC治疗后患者Ktrans、Ve、Kep值均明显低于NAC治疗前(P<0.05);pCR组Ktrans、Ve、Kep值均明显低于未缓解组(P<0.05);pCR组与未缓解组在年龄、肿瘤直径、生育情况、病理类型、NAC治疗方案、分子分型中比较,差异无统计学意义(P>0.05),pCR组TNM分期Ⅱ期占比高于未缓解组(88.24%vs 12.79%)(P<0.05);以组别(pCR组及未缓解组)为因变量,以TNM分期、Ktrans、Ve、Kep为自变量,进行Logistic回归分析结果显示:TNM分期[95%CI:(1.076~2.611)]、Ktrans[95%CI:(1.120~1.678)]、Ve[95%CI:(1.253~2.479)]、Kep[95%CI:(1.295~1.963)]为影响pCR的独立危险因素(P<0.01);ROC结果显示:Ktrans+Ve+Kep对pCR预测AUC值为0.879,高于Ktrans、Ve、Kep三者单独检测(P<0.05)。结论NAC治疗前后DCE-MRI定量参数Ktrans、Ve、Kep值存在明显变化,于NAC治疗后pCR患者中呈现更低水平;通过获取DCEMRI的影像数据,以预测NAC治疗后pCR的可行性高,有益于后续指导临床完善个体化治疗方案。

THP方案新辅助治疗HER-2阳性乳腺癌的真实世界研究

目的 了解THP方案在真实世界临床实践的应用状况,同时评价该方案的疗效、安全性和耐受性。方法 选择在保定市第一中心医院等河北省11家三级甲等医院接受THP方案新辅助治疗并完成序贯手术的HER-2阳性乳腺癌患者70例为研究对象,制订专用的患者资料信息收集表,专人负责收集符合纳入标准患者的临床病理资料。评估THP方案的有效性、安全性和耐受性。主要研究终点为病理完全缓解(pCR)率、≥3级不良反应的发生率、既定治疗方案完成率。结果 总人群pCR率为54.3%。亚组分析显示,cTNMⅠ-Ⅱ期、激素受体阴性、HER-2 IHC3+患者的pCR率分别显示出高于c TNMⅢ期、激素受体阳性、HER-2 IHC2+/FISH+患者的趋势,但差异无统计学意义(P>0.05)。4周期患者的pCR率显著高于4周期以上患者(P<0.05)。≥3级不良反应发生率为4.3%。既定方案完成率为98.6%。结论THP方案在河北省得到广泛应用,是HER-2阳性乳腺癌患者新辅助治疗的有效方案,安全性及耐受性良好,可以考虑作为激素受体阴性、肿瘤负荷较小、对联合化疗耐受性差患者的新辅助备选方案。

乳腺癌新辅助治疗后乳房与腋窝病理学完全缓解影响因素分析

目的探讨乳腺癌新辅助治疗(neoadjuvant therapy,NAT)后乳房及腋窝病理学完全缓解(pathological complete response,pCR)的影响因素,为NAT后腋窝手术降级的可行性提供一定参考。方法按照纳入与排除标准,回顾性收集吉林大学中日联谊医院2015年至今收治的NAT乳腺癌患者,纳入患者为乳腺癌伴同侧腋窝淋巴结转移,均接受了标准NAT后行乳腺癌改良根治术。收集患者相关指标,采用χ2检验和多因素Logistic回归分析影响乳房和腋窝pCR的因素,并探讨NAT后乳房pCR指导腋窝手术降级的可行性。结果本研究共纳入符合条件的患者110例,其中达到乳房pCR42例(38.2%),达到腋窝pCR 59例(53.6%),总体pCR 37例(33.6%)。单因素分析结果发现,N分期、雌激素受体(ER)、人表皮生长因子受体2(HER2)、Ki67、分子分型和新辅助方案与乳房pCR有关(P<0.05);ER、孕激素受体(PR)、HER2、分子分型、新辅助方案和乳房pCR与腋窝pCR有关(P<0.05)。进一步多因素Logistic回归分析结果显示,接受化疗联合双靶方案的患者相较接受多药化疗方案的患者更容易得到乳房pCR(OR=6.957,95%CI=1.124,43.043,P<0.05);达到乳房pCR患者相较未达到患者更容易得到腋窝pCR(OR=11.954,95%CI=3.475,41.114,P<0.001)。结论NAT后接受化疗联合双靶方案的患者获得乳房pCR的可能性较大,达到乳房pCR的患者获得腋窝pCR的可能性较大,乳房pCR对腋窝手术降级具有参考价值。

基于超声深度学习影像组学的乳腺癌新辅助化疗疗效预测

目的开发一种结合超声影像组学、深度学习和临床特征的综合模型,以预测乳腺癌新辅助化疗(Neoadjuvant Chemotherapy,NAC)后的病理完全缓解(Pathological Complete Response,pCR)。方法共纳入117例乳腺癌患者,按照7∶3的比例随机划分为训练集和验证集。采用Mann-Whitney U检验、随机森林递归消除算法和最小绝对收缩和选择算子进行特征筛选及影像组学/深度学习标签构建。对患者的临床参数进行单/多因素分析,以选择有效特征构建临床模型。然后利用逻辑回归算法将临床特征与影像组学、深度学习标签相结合,构建临床-影像组学-深度学习综合模型。从预测效果、校准能力和临床实用性方面评估模型性能。结果临床-影像组学-深度学习综合模型相比于单独的临床、影像组学和深度学习模型在训练集和验证集中均显示出最高的曲线下面积(训练集:0.949 vs.0.788 vs.0.815 vs.0.928;验证集:0.931 vs.0.643 vs.0.778 vs.0.901)。校准曲线和决策曲线证实综合模型具有良好的预测性能。结论与单一模型比较,综合模型对术前预测乳腺癌患者NAC后的pCR状态具有更高价值。