锝99m-甲氧基异丁基异腈闪烁显像对乳腺癌患者化疗反应的预测

Prediction of chemotherapeutic response by Technetium 99m--MIBI scintigraphy in breast carcinoma patients.

作者信息

Takamura Y, Miyoshi Y, Taguchi T, Noguchi S

机构信息

Department of Surgical Oncology, Osaka University Medical School, Osaka, Japan.

出版信息

Cancer. 2001 Jul 15;92(2):232-9. doi: 10.1002/1097-0142(20010715)92:2<232::aid-cncr1314>3.0.co;2-g.

DOI:10.1002/1097-0142(20010715)92:2<232::aid-cncr1314>3.0.co;2-g

PMID:11466674

Abstract

BACKGROUND

Significance of Technetium 99m ((99m)Tc)-MIBI scintigraphy in the prediction of response to anthracylines and taxanes (both are substrates for P-glycoprotein [P-gp]) as well as relation between (99m)Tc-MIBI uptake and P-gp or MDR1 mRNA expression in tumors were studied in patients with breast carcinoma.

METHODS

Forty-six female patients with locally advanced (n = 15) or metastatic (n = 31) breast carcinoma were recruited in this study. Before chemotherapy (epirubicin and cyclophosphamide [n = 20] or decetaxel [n = 26]), (99m)Tc-MIBI scintigraphy was performed to obtain the T/N (tumor to normal tissue) ratios of (99m)Tc-MIBI uptake at 10 minutes (T/N[e]) and at 180 minutes (T/N[d]) after the (99m)Tc-MIBI injection. Expression of MDR1 mRNA and P-gp in tumors (n = 32) were determined by a quantitative real-time polymerase chain reaction and immunohistochemistry, respectively.

RESULTS

Clinical significance of T/N(e) and T/N(d) ratios in the prediction of chemotherapeutic response was evaluated using the arbitrary cutoff values of 3.0 for T/N(e) ratios and 2.0 for T/N(d) ratios. Positive predictive value, negative predictive value, and diagnostic accuracy of T/N(d) ratios (81.0%, 96.0%, and 89.1%, respectively) were higher, although statistically not significant, than those of T/N(e) ratios (73.3%, 77.4%, and 76.1%, respectively), and these values were not affected by type of chemotherapy. MDR1 mRNA levels were not significantly different between the lesions with high (> or = 2.0) and low (< 2.0) T/N(d) ratios, but P-gp expression was significantly (P < 0.01) higher in the lesions with low T/N(d) ratios than in those with high T/N(d) ratios.

CONCLUSIONS

T/N(d) ratios determined by (99m)Tc-MIBI scintigraphy are useful in the prediction of response to chemotherapy with epirubicin and cyclophosphamide or docetaxel as well as in the in vivo evaluation of P-gp expression status in tumors in patients with locally advanced or recurrent breast carcinoma.

摘要

背景

研究了锝99m（99mTc）-甲氧基异丁基异腈闪烁显像在预测蒽环类药物和紫杉烷类药物（二者均为P-糖蛋白[P-gp]的底物）反应中的意义，以及99mTc-甲氧基异丁基异腈摄取与乳腺癌患者肿瘤中P-gp或多药耐药基因1（MDR1）mRNA表达之间的关系。

方法

本研究纳入了46例局部晚期（n = 15）或转移性（n = 31）乳腺癌女性患者。在化疗（表柔比星和环磷酰胺[n = 20]或多西他赛[n = 26]）前，进行99mTc-甲氧基异丁基异腈闪烁显像，以获取99mTc-甲氧基异丁基异腈注射后10分钟（T/N[e]）和180分钟（T/N[d]）时99mTc-甲氧基异丁基异腈摄取的肿瘤与正常组织（T/N）比值。分别通过定量实时聚合酶链反应和免疫组织化学测定32例肿瘤中MDR1 mRNA和P-gp的表达。

结果

使用T/N[e]比值的任意临界值3.0和T/N[d]比值的2.0评估T/N[e]和T/N[d]比值在预测化疗反应中的临床意义。T/N[d]比值的阳性预测值、阴性预测值和诊断准确性（分别为81.0%、96.0%和89.1%）高于T/N[e]比值（分别为73.3%、77.4%和76.1%），尽管在统计学上无显著差异，且这些值不受化疗类型的影响。T/N[d]比值高（≥2.0）和低（<2.0）的病变之间MDR1 mRNA水平无显著差异，但T/N[d]比值低的病变中P-gp表达显著高于（P < 0.01）T/N[d]比值高的病变。