1HMR 波谱法测定总胆碱作为局部晚期乳腺癌新辅助治疗后反应的早期预测指标：免疫组织化学状态的影响。

Total choline quantification measured by 1H MR spectroscopy as early predictor of response after neoadjuvant treatment for locally advanced breast cancer: The impact of immunohistochemical status.

机构信息

Radiology Department, Institute Jules Bordet, Brussels, Belgium.

Nuclear Department, Institute Jules Bordet, Brussels, Belgium.

出版信息

J Magn Reson Imaging. 2018 Oct;48(4):982-993. doi: 10.1002/jmri.26042. Epub 2018 Apr 16.

DOI:10.1002/jmri.26042

PMID:29659077

Abstract

BACKGROUND

Validation of new biomarkers is essential for the early evaluation of neoadjuvant treatments.

PURPOSE

To determine whether measurements of total choline (tCho) by 1H spectroscopy could predict morphological or pathological complete response (pCR) of neoadjuvant treatment and whether breast cancer subgroups are related to prediction accuracy.

STUDY TYPE

Prospective, nonrandomized, monocentric, diagnostic study.

POPULATION

Sixty patients were initially included with 39 women participating in the final cohort.

FIELD STRENGTH/SEQUENCE: A 1.5T scanner was used for acquisition and MRS was performed using the syngo GRACE sequence.

ASSESSMENT

MRS and MRI examinations were performed at baseline (TP1), 24-72 hours after first chemotherapy (TP2), after the end of anthracycline treatment (TP3), and MRI only after the end of taxane treatment (TP4). Early (EMR) and late (LMR) morphological response were defined as %ΔDmax13 or %ΔDmax14, respectively. Responders were patients with %ΔDmax >30. Pathological complete response (pCR) patients achieved a residual cancer burden score of 0.

STATISTICAL TESTS

T-test, receiver operating characteristic (ROC) curves, multiple regression, logistic regression, one-way analysis of variance (ANOVA) analysis were used for the analysis.

RESULTS

At TP1 there was a significant difference between response groups for tCho1 concerning EMR prediction (P = 0.05) and pCR (P < 0.05) and for K 1 (P = 0.03) concerning LMR prediction. At TP2, no modification of tCho and other parameters could predict response. At TP3, ΔtCho, ΔDmax, and ΔVol could predict LMR (P < 0.05 for all parameters), pCR (P < 0.05 for all parameters), and ΔK could predict only pCR (P = 0.04). Logistic regression at baseline showed the highest area under the curve (AUC) of 0.9 for prediction of pCR. The triple negative (TN) subgroup showed significantly higher tCho at baseline (P = 0.02) and higher ΔtCho levels at TP3 (P < 0.05).

DATA CONCLUSION

Baseline measurements of tCho in combination with clinicopathological criteria could predict non-pCR with a high AUC. Furthermore, tCho quantification for prediction of pCR was more sensitive for TN tumors.

LEVEL OF EVIDENCE

1 Technical Efficacy: Stage 4 J. Magn. Reson. Imaging 2018;48:982-993.

摘要

背景

新生物标志物的验证对于新辅助治疗的早期评估至关重要。

目的

确定 1H 波谱测量总胆碱（tCho）是否可以预测新辅助治疗的形态学或病理完全缓解（pCR），以及乳腺癌亚组是否与预测准确性相关。

研究类型

前瞻性、非随机、单中心、诊断性研究。

人群

最初纳入 60 例患者，其中 39 例女性参与最终队列。

场强/序列：使用 1.5T 扫描仪进行采集，使用 syngo GRACE 序列进行 MRS。

评估

MRS 和 MRI 检查在基线（TP1）、首次化疗后 24-72 小时（TP2）、蒽环类药物治疗结束后（TP3）和紫杉醇治疗结束后仅行 MRI（TP4）时进行。早期（EMR）和晚期（LMR）形态学反应分别定义为%ΔDmax13 或%ΔDmax14。应答者为%ΔDmax >30 的患者。病理完全缓解（pCR）患者的残留癌负荷评分为 0。

统计检验

使用 t 检验、受试者工作特征（ROC）曲线、多元回归、逻辑回归、单因素方差（ANOVA）分析进行分析。

结果

在 TP1，在 EMR 预测（P=0.05）和 pCR（P<0.05）方面，反应组之间 tCho1 存在显著差异，在 LMR 预测方面，K1 存在显著差异（P=0.03）。在 TP2 时，tCho 和其他参数的变化均不能预测反应。在 TP3，ΔtCho、ΔDmax 和ΔVol 可预测 LMR（所有参数的 P<0.05）、pCR（所有参数的 P<0.05），而ΔK 仅能预测 pCR（P=0.04）。基线时的逻辑回归显示，pCR 预测的曲线下面积（AUC）最高，为 0.9。三阴性（TN）亚组在基线时的 tCho 明显更高（P=0.02），在 TP3 时的ΔtCho 水平更高（P<0.05）。