肿瘤影像学2024，Vol.33Issue(6) ：593-601.DOI:10.19732/j.cnki.2096-6210.2024.06.004

超声联合临床病理学特征的列线图评分模型对HER2阳性乳腺癌NAC后pCR的预测价值

The predictive value of nomogram scoring model based on ultrasound and clinicopathological features to predict pCR in HER2 positive breast cancer after NAC

王昕玥 曹琨芃 束华 邓红艳 李璐 徐超丽 叶新华
肿瘤影像学2024，Vol.33Issue(6) ：593-601.DOI:10.19732/j.cnki.2096-6210.2024.06.004
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超声联合临床病理学特征的列线图评分模型对HER2阳性乳腺癌NAC后pCR的预测价值

The predictive value of nomogram scoring model based on ultrasound and clinicopathological features to predict pCR in HER2 positive breast cancer after NAC

王昕玥 1曹琨芃 1束华 1邓红艳 1李璐 1徐超丽 1叶新华1
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作者信息

  • 1. 南京医科大学第一附属医院超声诊断科,江苏 南京 210029
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摘要

目的:探讨常规超声联合病理学特征的列线图评分模型对人表皮生长因子受体2(human epidermal growth factor receptor 2,HER2)阳性乳腺癌新辅助化疗(neoadjuvant chemotherapy,NAC)后病理学完全缓解(pathologic complete response,pCR)的预测价值.方法:回顾并分析2022年1月—2023年8月于南京医科大学第一附属医院经超声引导下粗针穿刺活检诊断为HER2阳性且接受8个周期NAC的乳腺癌患者的临床资料.所有患者NAC后均行病侧乳腺癌改良根治术并获得大体病理学检查结果,根据Miller-Payne分级,将患者分为病理学完全缓解(pCR)组与非病理学完全缓解(non-pCR)组.采用t检验或χ2检验/Fisher精确概率检验分析两组患者临床病理学资料、超声影像学特征的差异.采用二元logistic回归分析确定HER2阳性乳腺癌pCR的独立预测因素,并建立列线图可视化相关因素对pCR的预测效能.结果:共纳入103例患者,其中pCR组51例,non-pCR组52例.两组单因素分析示:临床病理学特征中肿块分子分型(χ2=12.266,P＜0.001)和超声特征中每两个周期NAC后同一病灶最长径变化率ΔD2、ΔD4、ΔD6、ΔD8(t=-2.760,P=0.007;t=-2.557,P=0.012;t=-4.006,P＜0.001;t=-2.872,P=0.005)与体积变化率ΔV2、ΔV4、ΔV6、ΔV8(t=-4.167,P＜0.001;Z=-3.443,P＜0.001;Z=-4.518,P＜0.001;Z=-3.708,P＜0.001)以及第4个周期肿块血流阻力指数(resistance index,RI)、第6个周期肿块RI、第8个周期肿块RI在两组患者间差异有统计学意义(Z=-2.108,P=0.035;Z=-2.386,P=0.017;Z=-3.708,P＜0.001).二元logistic回归分析示:肿块分子分型(OR=0.15,95%CI 0.03～0.64,P=0.005)及第2周期NAC后肿块体积变化率ΔV2(OR=121.47,95%CI 4.25～3 468.72,P=0.010)为HER2阳性乳腺癌患者NAC后pCR的独立预测因素(P＜0.05).联合两者构建列线图模型,该模型的受试者工作特征(receiver operating characteristic,ROC)曲线下面积(area under curve,AUC)为0.82(95%CI 0.74～0.91),灵敏度为85%,特异度为75%.校准图及决策曲线分析(decision curve analysis,DCA)均显示其在临床评估方面有良好的应用价值.结论:超声联合病理学特征列线图评分模型对HER2阳性乳腺癌NAC后pCR有良好的预测价值,有助于HER2阳性乳腺癌NAC后续治疗方案的临床决策.

Abstract

Objective:To investigate the predictive value of a scoring model based on conventional ultrasound combined with clinicopathological features for pathologic complete response(pCR)in human epidermal growth factor receptor 2(HER2)positive breast cancer after neoadjuvant chemotherapy(NAC).Methods:A retrospective analysis was performed in patients who confirmed as HER2 positive breast cancer by ultrasound-guided coarse needle biopsies and followed by eight cycles of NAC from January 2022 to August 2023 in The First Affiliated Hospital of Nanjing Medical University.According to the Miller-Payne grading system,the patients were divided into pathological complete response(pCR)group and non-pathological complete response(non-pCR)group.The differences of clinical and pathological data and ultrasound imaging features between the two groups were analyzed by t test or χ2/Fisher test.Multivariate regression analysis was used to determine the independent predictors of pCR in HER2 positive breast cancer,and a nomogram was established to visualize the predictive efficacy of related factors for pCR.Results:A total of 103 patients were included,51 in the pCR group and 52 in the non-pCR group.Univariate analysis revealed significant differences between pCR and non-pCR groups regarding tumor molecular classification(χ2=12.266,P＜0.001),as well as the ultrasound features including the rate of longest diameter change ΔD2,ΔD4,ΔD6,ΔD8(t=-2.760,P=0.007;t=-2.557,P=0.012;t=-4.006,P＜0.001;t=-2.872,P=0.005)and volume change rate ΔV2,ΔV4,ΔV6,ΔV8(t=-4.167,P＜0.001;Z=-3.443,P＜0.001;Z=-4.518,P＜0.001;Z=-3.708,P＜0.001)along with resistance index(RI)measurements in the 4th,the 6th and the 8th cycle(Z=-2.108,P=0.035;Z=-2.386,P=0.017;Z=-3.708,P＜0.001).Multivariate analysis showed that tumor molecular type(OR=0.15,95%CI 0.03-0.64,P=0.005)and tumor volume change rate after the second cycle of NAC ΔV2(OR=121.47,95%CI 4.25-3468.72,P=0.010)were independent predictors of pCR in HER2 positive breast cancer after NAC(P＜0.05).The area under the receiver operating characteristic(ROC)curve(AUC)of the nomogram model was 0.82(95%CI 0.74-0.91),the sensitivity was 85%,and the specificity was 75%.Calibration chart and decision curve analysis(DCA)showed it has good application value in clinical evaluation.Conclusion:The developed nomogram scoring model integrating ultrasound and clinicopathological features demonstrates strong predictive potential for identifying pCR among HER2 positive breast cancer patients post-NAC,thereby offering valuable insights into subsequent treatment decisions.

关键词

乳腺癌/超声/人类表皮生长因子受体2/新辅助化疗/病理学完全缓解/列线图

Key words

Breast cancer/Ultrasound/Human epidermal growth factor receptor 2/Neoadjuvant chemotherapy/Pathological complete response/Nomogram

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出版年

2024
肿瘤影像学
复旦大学附属肿瘤医院

肿瘤影像学

CSTPCD
影响因子：0.67
ISSN：1008-617X
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