摘要
目的探讨基于体素内不相干运动(IVIM)的多参数MRI在预测乳腺癌新辅助化疗(NAC)疗效中的价值。方法选取经穿刺病理证实为乳腺癌后接受全程NAC,并于NAC后行手术治疗的患者97例,按照7∶3的比例将患者随机分为训练集与测试集。根据Miller&Payne病理反应分级标准将两数据集患者分为完全缓解组(pCR组)与非完全缓解组(N-pCR组)。采集患者MRI特征、参数及临床病理特征,基于多因素分析结果构建乳腺癌NAC疗效联合预测模型。结果97例患者中包括pCR 30例(训练集21例,测试集9例),N-pCR 67例(训练集46例,测试集21例)。训练集中,pCR组的ADC值及D值均低于N-pCR组(P均<0.001),且pCR组患者PR多呈阴性表达(P<0.001),HER-2多呈阳性表达(P=0.001),ki-67以高表达为主(P=0.013)。Logistics回归显示D(OR=0.012,P=0.049),PR(OR=28.137,P=0.020),HER-2(OR=0.045,P=0.005),Ki-67(OR=0.082,P=0.046)为乳腺癌NAC疗效的独立预测因素。预测模型在训练集、测试集的AUC分别为0.935(95%CI:0.877~0.993)、0.894(95%CI:0.767~1.000)。结论基于IVIM的多参数MRI可于治疗前预测乳腺癌NAC疗效,为临床预后评估提供有用参考。
Objective The objective of this study is to investigate the value of multi-parameter magnetic resonance imaging(MRI)based on the intravoxel incoherent motion(IVIM)in predicting the effectiveness of neoadjuvant chemotherapy(NAC)for breast cancer.Methods Ninety-seven breast cancer patients,whose diagnosis was validated by puncture pathology,were collected after receiving NAC followed by surgical intervention.The patients were allocated at random to either a training dataset or a validation dataset,with a proportional distribution of 70%to the training set and 30%to the validation set.According to the Miller&Payne pathological response grading standard,the patients in the two data sets were divided into pCR group and N-pCR group.The MRI features,parameters and clinicopathological features of the patients were collected,and the combined prediction model of NAC efficacy in breast cancer was constructed based on the results of multivariate analysis.Results Among the 97 patients,30 achieved pCR(21 in the training set and 9 in the test set),while 67 were classified as N-pCR(46 in the training set and 21 in the test set).In the training set,both ADC and D values were significantly lower in the pCR group compared to the N-pCR group(both P<0.001).Additionally,patients in the pCR group were more likely to have negative PR expression(P<0.001),positive HER-2 expression(P=0.001),and high Ki-67 expression(P=0.013).Logistic regression analysis identified D(OR=0.012,P=0.049),PR(OR=28.137,P=0.020),HER-2(OR=0.045,P=0.005),and Ki-67(OR=0.082,P=0.046)as independent predictive factors for the efficacy of NAC in breast cancer.The predictive model demonstrated AUC values of 0.935(95%CI:0.877-0.993)in the training set and 0.894(95%CI:0.767-1.000)in the test set.Conclusion Multiparameter magnetic resonance imaging based on IVIM can predict the efficacy of NAC in breast cancer before treatment,and provide a useful reference for clinical prognosis evaluation.
作者
王奕文
王正通
王唯伟
孙占国
WANG Yiwen;WANG Zhengtong;WANG Weiwei;SUN Zhanguo(Clinical Medical College,Jining Medical University,Jining 272002,China;Department of Medical Imaging,Affiliated Hospital of Jining Medical University,Jining 272029,China)
出处
《医学影像学杂志》
2025年第5期66-71,共6页
Journal of Medical Imaging
基金
山东省济宁市重点研发计划项目(编号:2023YXNS095、2023YXNS133)
济宁医学院贺林院士新医学临床转化工作站科研基金项目(编号:JYHL2022FMS07)。
关键词
乳腺癌
磁共振成像
体素内不相干运动成像
新辅助化疗
Breast cancer
Magnetic resonance imaging
Intravoxel incoherent motion imaging
Neoadjuvant chemotherapy
