Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California.
Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Proton Beam Therapy Center, Sapporo, Hokkaido, Japan.
Clin Cancer Res. 2017 Jul 1;23(13):3334-3342. doi: 10.1158/1078-0432.CCR-16-2415. Epub 2017 Jan 10.
To identify novel breast cancer subtypes by extracting quantitative imaging phenotypes of the tumor and surrounding parenchyma and to elucidate the underlying biologic underpinnings and evaluate the prognostic capacity for predicting recurrence-free survival (RFS). We retrospectively analyzed dynamic contrast-enhanced MRI data of patients from a single-center discovery cohort ( = 60) and an independent multicenter validation cohort ( = 96). Quantitative image features were extracted to characterize tumor morphology, intratumor heterogeneity of contrast agent wash-in/wash-out patterns, and tumor-surrounding parenchyma enhancement. On the basis of these image features, we used unsupervised consensus clustering to identify robust imaging subtypes and evaluated their clinical and biologic relevance. We built a gene expression-based classifier of imaging subtypes and tested their prognostic significance in five additional cohorts with publically available gene expression data but without imaging data ( = 1,160). Three distinct imaging subtypes, that is, homogeneous intratumoral enhancing, minimal parenchymal enhancing, and prominent parenchymal enhancing, were identified and validated. In the discovery cohort, imaging subtypes stratified patients with significantly different 5-year RFS rates of 79.6%, 65.2%, 52.5% (log-rank = 0.025) and remained as an independent predictor after adjusting for clinicopathologic factors (HR, 2.79; = 0.016). The prognostic value of imaging subtypes was further validated in five independent gene expression cohorts, with average 5-year RFS rates of 88.1%, 74.0%, 59.5% (log-rank from <0.0001 to 0.008). Each imaging subtype was associated with specific dysregulated molecular pathways that can be therapeutically targeted. Imaging subtypes provide complimentary value to established histopathologic or molecular subtypes and may help stratify patients with breast cancer. .
为了通过提取肿瘤和周围实质的定量成像表型来鉴定新型乳腺癌亚型,并阐明潜在的生物学基础,以及评估预测无复发生存率(RFS)的预后能力。我们回顾性分析了来自单中心发现队列(= 60)和独立多中心验证队列(= 96)的患者的动态对比增强 MRI 数据。提取定量图像特征以描述肿瘤形态、对比剂洗脱模式的肿瘤内异质性以及肿瘤周围实质增强。基于这些图像特征,我们使用无监督共识聚类来识别稳健的成像亚型,并评估其临床和生物学相关性。我们构建了一个基于基因表达的成像亚型分类器,并在五个具有公开基因表达数据但无成像数据的附加队列中测试了其预后意义(= 1160)。确定并验证了三种不同的成像亚型,即肿瘤内均匀增强、最小实质增强和显著实质增强。在发现队列中,成像亚型分层患者的 5 年 RFS 率有显著差异,分别为 79.6%、65.2%、52.5%(对数秩检验= 0.025),并且在调整临床病理因素后仍然是独立的预测因素(HR,2.79;= 0.016)。成像亚型的预后价值在五个独立的基因表达队列中进一步得到验证,平均 5 年 RFS 率分别为 88.1%、74.0%、59.5%(对数秩检验从<0.0001 到 0.008)。每种成像亚型都与特定的失调分子途径相关,这些途径可以作为治疗靶点。成像亚型为已建立的组织病理学或分子亚型提供了补充价值,并可能有助于分层乳腺癌患者。
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