摘要
目的:探讨乳腺癌治疗前多模态MRI联合血清miR-125b水平预测新辅助化疗疗效的价值.方法:研究对象为于我院首次接受全程新辅助化疗并行手术切除治疗的90例女性乳腺癌患者.治疗前对患者进行乳腺MRI检查,记录病灶直径、边缘、形状、平扫T2WI图像上病灶内是否高信号和时间信号强度曲线(TIC)类型、表观扩散系数(ADC)、单纯扩散系数(D)、伪扩散系数(D*)及灌注分数(f).依据Miller-Payne分级标准对病理学反应进行评估,分为病理反应不佳(NR)组和病理反应良好(R)组.结果:乳腺癌患者新辅助化疗后R组52例(57.78％),NR组38例(42.22％),两组的年龄、临床分期、病理类型、雌激素受体(ER)、孕激素受体(PR)和人表皮生长因子受体2(HER2)表达水平差异无统计学意义(P＞0.05).R组中Ki-67＞14％的比例显著高于NR组(P＜0.05).R组与NR组的肿瘤直径、边缘、形状、T2WI信号、D值和D*值差异均无统计学意义(P＞0.05).R组的TIC类型为Ⅲ型的比例显著高于NR组,ADC值显著低于NR组,f值显著高于NR组(P＜0.05).R组的血清miR-125b相对表达量显著低于NR组(t=-11.007,P＜0.001).二元Logistic回归分析结果显示,较高的ADC值、血清miR-125b水平和较低的f值是乳腺癌新辅助化疗后疗效为NR的独立危险因素(P＜0.05).ADC值、f值、血清miR-125b水平及三者联合预测乳腺癌新辅助化疗疗效的AUC分别为0.863(95％CI:0.799～0.927,P＜0.001)、0.819(95％CI:0.744～0.893,P＜0.001)、0.832(95％CI:0.755～0.908,P＜0.001)和0.958(95％CI:0.929～0.988,P＜0.001).结论:治疗前多模态MRI联合血清miR-125b水平对乳腺癌患者新辅助化疗疗效具有一定的预测价值.
Abstract
Objective:This study was designed to investigate the value of multimodal MRI com-bined with serum miR-125b level in predicting the efficacy of neoadjuvant chemotherapy before breast cancer treatment.Methods:A total of 90 female breast cancer patients who received neoadjuvant chem-otherapy and surgical resection for the first time in our hospital from January 2021 to June 2022 were selected as subjects.Breast MRI was performed on the patients.Lesion diameter,edge,shape,intracra-nial high signal,parenchymal background enhancement degree,time-signal intensity curve(TIC)type,apparent diffusion coefficient(ADC),simple diffusion coefficient(D),pseudo-diffusion coeffi-cient(D*),and perfusion fraction(f)were recorded on plain T2WI images.Pathological responses were assessed according to Millerand Payne grading criteria,and were divided into mild pathological response(NR)group and good pathological response(R)group.Results:52 cases(57.78％)in R group and 38 cases(42.22％)in NR group after neoadjuvant chemotherapy were observed.There were no significant differences in age,clinical stage,pathological type,ER,PR and HER2 expression levels between the two groups(P＞0.05).The proportion of Ki-67＞14％in R group was significantly high-er than that in NR group(P＜0.05).There were no significant differences in tumor diameter,margin,shape,T2WI signal,D value and D*value between R and NR groups(P＞0.05).The proportions of severe background enhancement and TIC type Ⅲ in R group were significantly higher than those in NR group,ADC value was significantly lower than that in NR group,and f value was significantly higher than that in NR group(P＜0.05).The relative expression level of miR-125b in R group was significantly lower than that in NR group(t=-11.007,P＜0.001).Binary Logistic regression analysis showed that higher ADC value,serum miR-125b level and lower f value were independent risk factors for therapeutic NR after neoadjuvant chemotherapy(P＜0.05).The AUCs of ADC value,f value,ser-um miR-125b level and their combination in predicting the efficacy of neoadjuvant chemotherapy for breast cancer were 0.863(95％CI:0.799～0.927,P＜0.001)、0.819(95％CI:0.744～0.893,P＜0.001)、0.832(95％CI:0.755～0.908,P＜0.001)and 0.958(95％CI:0.929～0.988,P＜0.001).Conclusion:Multimodal MRI combined with serum miR-125b level before treatment has certain predictive value for the efficacy of breast cancer patients after neoadjuvant chemotherapy.
维普
万方数据