|摘要||目的 评估局部进展期乳腺癌患者在术前新辅助化疗(neoadjuvant chemotherapy,NAC)前后癌灶最大径、体积及两者的变化率对NAC病理反应性的价值. 方法 36例病例均根据术后病理反应性结果(Miller & Payne 分级)分为组织学显著反应(major histological response,MHR)与组织学非显著反应(non-major histological response,NMHR)2组,对2组NAC前、NAC第2周期后、NAC第4周期后于乳腺容积成像(volume imaging of breast,VIBRANT)动脉早期测量的癌灶最大径、体积及其变化率分别进行两独立样本t检验比较(非正态分布的数据进行Mann-Whitney U检验);采用Concordance correlation coefficient (CCC)分析3次MR测量的癌灶最大径与体积之间的一致性.利用受试者工作特征曲线(receiver operating characteristic curve,ROC)分析判断MR测量的癌灶大小对NAC病理反应性的评估价值. 结果 NAC前后,MHR组3次MR测量的癌灶最大径 [(2.75±1.16) cm、(2.19±1.07) cm、(1.58±0.75) cm ] 及最大径第 1 次变化率[(21.70±15.09)%] 与 NMHR 组 3次最大径[(2.71±1.10) cm、(2.33±0.90) cm、(2.01±0.94) cm]及第1次变化率[(11.68±10.27)% ]均无统计学差异(P>0.05),但MHR组癌灶最大径第2次变化率[(39.00±15.38)% ]显著高于NMHR组[(25.83±21.77)%],差异有统计学意义(P=0.04).NAC前后,MHR组3次MR测量的癌灶体积[中位14.00 cm~3 (范围2.96～83.41 cm~3)、中位7.31 cm~3(范围0.05～55.35 cm~3)、中位2.69 cm~3(范围0～33.40 cm~3) ] 及体积第1次变化率[中位48.65%(范围33.64%～98.48%)]与NMHR组3次体积[中位4.25 cm~3(范围4.78～106.55 cm~3)、中位10.53 cm~3(范围1.72～42.85 cm~3)、中位7.56 cm~3(范围0.68～156.58 cm~3)]及第1次变化率[中位52.04%(范围-35.79%～78.31%)] 均无统计学差异(P>0.05),但MHR组癌灶体积第2次变化率[中位85.37%(范围27.52%～100%)]显著高于NMHR组[中位68.80%(范围-289.60%～94.24%)],差异有统计学意义(P=0.01).NAC前后,3次MR测量的最大径与体积之间的一致性系数分别为0.82、0.67、0.55,总体一致性系数为0.78.以NAC后癌灶最大径和体积第2次变化率为评估参数、术后病理反应性为金标准,ROC曲线下面积分别为0.75、0.80,两者评估效能无显著性差异(P=0.61). 结论 MR测量乳腺癌灶最大径与体积的一致性较好.NAC第4个周期后,癌灶最大径与体积两者的第2次变化率可评估癌灶对NAC的病理反应性,但评估效能均较低且无显著性差异.
Objective To investigate the clinical value of tumor's longest diameter and volume in assessing pathologic response in locally advanced breast cancer treated with neoadjuvant chemotherapy(NAC).Methods A prospective study was undertaken in women undergoing NAC for locally advanced breast cancer in order to determine the ability of quantitative MRI to assess the final pathologic response. 36 cases with pathologically confirmed locally advanced breast cancer who had been undergone four courses of NAC underwent preoperative breast MRI three times during the NAC. Pathologic response was assessed according Miller & Payne grading system, of which grade 4 and 5 defined as major histological response (MHR), and grade 1 to 3 as non-major histological response (NMHR). The tumor's longest diameters and volumes in MHR were compared with those in NMHR by Mann-Whitney U test before, after the second and fourth cycle of NAC. Concordance correlation coefficient (CCC) were assessed to evaluate the agreement between the two method. Receiver operating characteristic curve (ROC) analysis was carried out to assess the clinical value of tumor size and the change rate.Results Before,after the second and the fourth cycle of NAC, the difference of tumor's longest diameters and their first change rate between MHR [(2.75±1.16) cm,(2.19±1.07) cm ,(1.58±0.75) cm and (21.70±15.09)%]respectively,and NMHR [(2.71±1.10) cm,(2.33±0.90) cm,(2.01±0.94) cm and (11.68±10.27)%] respectively were not significant(P>0.05). The second change rate of tumor's longest diameter in MHR [(39.00±15.38)% ] was significantly higher than that in NMHR[ (25.83±21.77)% ](P=0.04). Before, after the second and the fourth cycly of NAC, the differences of tumor volumes and their first change rate between MHR [ median 14.00 cm~3 ( range 2.96～83.41 cm~3 ) , median 7.31 cm~3 (range 0.05～55.35 cm~3), median 2.69 cm~3 (range 0～33.40 cm~3 ) , median 48.65% (range 33.64%～98.48%) ] and NMHR [median 4.25 cm~3 (range 4.78～106.55 cm~3), median 10.53 cm~3 (range 1.72～42.85 cm~3), median 7.56 cm~3 (range 0.68～156.58 cm~3), median 52.04% (range-35.79%～78.31%) ] were not significant. The second changing rate of tumor's volume in MHR [median 85.37% (ranged 27.52%～100%)] was significantly higher than that in NMHR [median 68.80% (ranged -289.60%～94.24%)](P=0.01). CCC was computed before and (0.82), after the second cycle (0.67) and after the fourth cycle (0.55), in all examinations pooled together (0.78).The second change rates of tumor's longest diameter and volume were equal to predict the final pathologic response, and the area under curve were 0.75 and 0.80, respectively (P=0.61). Conclusion The agreement between the tumor's longest diameters and tumor's volumes is good in all in breast carcinoma. The assessment efficacy of the change rate of tumor's longest diameter and that of volume were low.|