Value of dynamic enhanced MRI parameters combined with peripheral blood siri in predicting recurrence and metastasis of triple negative breast cancer after modified radical surgery
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目的 探讨动态增强磁共振成像(magnetic resonance imaging,MRI)参数联合外周血全身炎症反应指数(systemic inflammatory response index,SIRI)预测三阴性乳腺癌(triple-negative breast cancer,TNBC)改良根治术后复发转移的价值.方法 对2019年1月至2021年12月于绍兴市上虞人民医院和舟山市妇幼保健院行改良根治术的351例TNBC患者进行为期2年随访,按照术后是否复发分为复发组(32例)及未复发组(319例),收集患者临床资料,分析影响患者术后复发的危险因素,记录患者术前动态增强MRI参数及外周血SIRI水平,分析二者对患者术后复发的预测价值.结果 两组临床分期、术前是否接受新辅助化疗构成比比较,差异有统计学意义(x2=19.56、7.53,P均＜0.05).复发组不规则肿瘤形态占比高于未复发组(x2=9.031,P均＜0.05).复发组感兴趣区转运常数Ktrans、反流速率常数Kep及SIRI水平均高于未复发组(x2=15.26、3.89、10.10,P均＜0.05),两组血浆容积分数Vp、达峰时间(time to peak,TTP)比较,差异无统计学意义(P＞0.05).多因素Logistic回归分析显示:临床分期为Ⅲ期、术前未接受新辅助化疗、术前不规则肿瘤形态、高Ktrans值、高Kep值及高SIRI水平均为TNBC患者术后复发转移的危险因素.ROC结果显示,术前Ktrans、术前Kep、SIRI预测TNBC患者术后复发转移的曲线下面积(area under the curve,AUC)分别为0.797、0.737、0.741;三者联合预测TNBC患者术后复发转移的AUC为0.797,敏感度为59.4％,特异度为94.36％(均P＜0.05).结论 高Ktrans值、高Kep值及高SIRI水平均为TNBC患者术后复发转移的危险因素,三者联合预测TNBC患者术后复发转移的曲线下面积及敏感度、特异度较高.
Objective To investigate the value of dynamic enhanced magnetic resonance imaging(MRI)parameters combined with peripheral blood systemic inflammatory response index(SIRI)in predicting recurrence and metastasis after modified radical triple-negative breast cancer(TNBC).Methods A total of 351 TNBC pa-tients who received modified radical surgery in our hospital from Jan.2019 to Dec.2021 were followed up for 2 years,and were separated into the recurrence group(n=32)and the non-recurrence group(n=319)according to whether they had recurred after surgery.Clinical data of patients were collected,risk factors affecting postoperative recurrence were analyzed,preoperative dynamic enhanced MRI parameters and peripheral blood SIRI level of pa-tients were recorded,and the predictive value of both in postoperative recurrence was analyzed.Results There were statistically significant differences in clinical stage and preoperative neoadjuvant chemotherapy between the two groups(x2=19.56,7.53,P＜0.05).The proportion of irregular tumor morphology in recurrence group was higher than that in non-recurrence group(x2=9.031,P＜0.05).The levels of transport constant Ktrans,reflux rate constant Kepand SIRI in the recurrence group were higher(x2=15.26,3.89,10.10,P＜0.05),and there was no statistically significant difference in plasma volume fraction Vp and time to peak(TTP)between the two groups(P＞0.05).Mul-tivariate Logistic regression analysis showed that stage Ⅲ,no neoadjuvant chemotherapy before surgery,irregular tumor shape before surgery,high Ktrans value,high Kep value and high SIRI level were all risk factors for postopera-tive recurrence and metastasis in TNBC patients.ROC results showed that the area under the curve(AUC)of pre-operative Ktrans,preoperative Kep and SIRI in predicting postoperative recurrence and metastasis of TNBC patients were 0.797,0.737 and 0.741,respectively.The combined prediction of AUC for postoperative recurrence and metas-tasis of TNBC patients was 0.797,sensitivity was 59.4％,and specificity was 94.36％(all P＜0.05).Conclusions High Ktrans value,high Kep value and high SIRI level are all risk factors for postoperative recurrence and metastasis in TNBC patients.The area under the curve,sensitivity and specificity predicted by their combination for postopera-tive recurrence and metastasis in patients with TNBC are relatively higher.
Magnetic resonanceSystemic inflammatory response indexBreast cancerTriple-nega-tive breast cancerModified radical mastectomy
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