From the Department of Radiology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea (B.R.K., A.Y.); Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea (S.U.S., S.M.K., B.L.Y., M.J.); Department of Radiology (S.Y.K., N.C., S.M.H., S.H.L., J.M.C., W.K.M.) and Medical Research Collaborating Center (Y.C.), Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (S.Y.K., N.C., S.M.H., S.H.L., J.M.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.Y.K., N.C., S.M.H., S.H.L., J.M.C., W.K.M.).
Radiology. 2022 Aug;304(2):310-319. doi: 10.1148/radiol.211509. Epub 2022 May 10.
Background Little is known regarding findings at imaging associated with survival in patients with luminal breast cancer treated with neoadjuvant chemotherapy (NAC). Purpose To determine the relationship between imaging (MRI, US, and mammography) and clinical-pathologic variables in predicting distant metastasis-free survival (DMFS) and overall survival (OS) in patients with luminal breast cancer treated with NAC. Materials and Methods In this retrospective study, consecutive women with luminal breast cancer who underwent NAC followed by surgery were identified from the breast cancer registries of two hospitals. Women from one hospital between January 2003 and July 2015 were classified into the development cohort, and women from the other hospital between January 2007 and July 2015 were classified into the validation cohort. MRI scans, US scans, and mammograms before and after NAC (hereafter, referred to as pre- and post-NAC, respectively) and clinical-pathologic data were reviewed. Peritumoral edema was defined as the water-like high signal intensity surrounding the tumor on T2-weighted MRI scans. The prediction model was developed in the development cohort by using Cox regression and then tested in the validation cohort. Results The development cohort consisted of 318 women (68 distant metastases, 54 deaths) and the validation cohort consisted of 165 women (37 distant metastases, 14 deaths) (median age, 46 years in both cohorts). Post-NAC MRI peritumoral edema, age younger than 40 years, clinical N2 or N3, and lymphovascular invasion were associated with worse DMFS (all, < .05). Pre-NAC mammographic microcalcifications, post-NAC MRI peritumoral edema, age older than 60 years, and clinical T3 or T4 were associated with worse OS (all, < .05). The prediction model showed good discrimination ability (C index, 0.67-0.75 for DMFS and 0.70-0.77 for OS) and stratified prognosis into low-risk and high-risk groups (10-year DMFS rates, 79% vs 21%, respectively; and 10-year OS rates, 95%-96% vs 63%-67%, respectively) in the validation cohort. Conclusion MRI features and clinical-pathologic variables were identified that were associated with prolonged survival of patients with luminal breast cancer treated with neoadjuvant chemotherapy. © RSNA, 2022 . See also the editorial by Kataoka in this issue.
对于接受新辅助化疗 (NAC) 的 luminal 型乳腺癌患者，影像学检查与生存相关的结果知之甚少。目的：确定影像学（MRI、US 和乳腺 X 线摄影）与临床病理变量之间的关系，以预测接受 NAC 的 luminal 型乳腺癌患者的无远处转移生存率 (DMFS) 和总生存率 (OS)。材料与方法：本回顾性研究纳入了来自两家医院乳腺癌登记处的连续接受 NAC 后行手术的 luminal 型乳腺癌女性患者。一家医院的患者（2003 年 1 月至 2015 年 7 月）归入研发队列，另一家医院的患者（2007 年 1 月至 2015 年 7 月）归入验证队列。回顾分析患者 NAC 前后（分别简称 NAC 前和 NAC 后）的 MRI 扫描、US 扫描和乳腺 X 线摄影结果以及临床病理数据。T2 加权 MRI 扫描上肿瘤周围水样高信号强度定义为肿瘤周围水肿。采用 Cox 回归在研发队列中建立预测模型，然后在验证队列中进行测试。结果：研发队列包括 318 例患者（68 例远处转移，54 例死亡），验证队列包括 165 例患者（37 例远处转移，14 例死亡）（两个队列的中位年龄均为 46 岁）。NAC 后 MRI 肿瘤周围水肿、年龄小于 40 岁、临床 N2 或 N3 以及脉管侵犯与较差的 DMFS 相关（均 P <.05）。NAC 前乳腺 X 线摄影微钙化、NAC 后 MRI 肿瘤周围水肿、年龄大于 60 岁以及临床 T3 或 T4 与较差的 OS 相关（均 P <.05）。验证队列中，预测模型显示出良好的区分能力（DMFS 的 C 指数为 0.67-0.75，OS 的 C 指数为 0.70-0.77），并将低危和高危患者分为不同预后组（10 年 DMFS 率分别为 79%和 21%；10 年 OS 率分别为 95%-96%和 63%-67%）。结论：识别出与接受新辅助化疗的 luminal 型乳腺癌患者生存时间延长相关的 MRI 特征和临床病理变量。© 2022 RSNA。另见本期社论。
