Nizhny Novgorod Regional Clinical Oncology Dispensary, Delovaya St., 11/1, Nizhny Novgorod, Russia, 603126.
Privolzhsky Research Medical University, Minina Square, 10/1, Nizhny Novgorod, Russia, 603950.
Breast Cancer Res. 2023 Jan 30;25(1):12. doi: 10.1186/s13058-023-01607-6.
Breast cancer neoadjuvant chemotherapy (NACT) allows for assessing tumor sensitivity to systemic treatment, planning adjuvant treatment and follow-up. However, a sufficiently large number of patients fail to achieve the desired level of pathological tumor response while optimal early response assessment methods have not been established now. In our study, we simultaneously assessed the early chemotherapy-induced changes in the tumor volume by ultrasound (US), the tumor oxygenation by diffuse optical spectroscopy imaging (DOSI), and the state of the tumor vascular bed by Doppler US to elaborate the predictive criteria of breast tumor response to treatment.
A total of 133 patients with a confirmed diagnosis of invasive breast cancer stage II to III admitted to NACT following definitive breast surgery were enrolled, of those 103 were included in the final analysis. Tumor oxygenation by DOSI, tumor volume by US, and tumor vascularization by Doppler US were determined before the first and second cycle of NACT. After NACT completion, patients underwent surgery followed by pathological examination and assessment of the pathological tumor response. On the basis of these, data regression predictive models were created.
We observed changes in all three parameters 3 weeks after the start of the treatment. However, a high predictive potential for early assessment of tumor sensitivity to NACT demonstrated only the level of oxygenation, ΔStO, (ρ = 0.802, p ≤ 0.01). The regression model predicts the tumor response with a high probability of a correct conclusion (89.3%). The "Tumor volume" model and the "Vascularization index" model did not accurately predict the absence of a pathological tumor response to treatment (60.9% and 58.7%, respectively), while predicting a positive response to treatment was relatively better (78.9% and 75.4%, respectively).
Diffuse optical spectroscopy imaging appeared to be a robust tool for early predicting breast cancer response to chemotherapy. It may help identify patients who need additional molecular genetic study of the tumor in order to find the source of resistance to treatment, as well as to correct the treatment regimen.
乳腺癌新辅助化疗（NACT）可评估肿瘤对全身治疗的敏感性，规划辅助治疗和随访。然而，现在还没有建立最佳的早期反应评估方法，因此，相当多的患者未能达到理想的病理肿瘤反应水平。在我们的研究中，我们同时通过超声（US）评估肿瘤体积的早期化疗诱导变化，通过漫射光学光谱成像（DOSI）评估肿瘤氧合状态，通过多普勒 US 评估肿瘤血管床状态，以阐述乳腺癌对治疗反应的预测标准。
共纳入 133 例经明确诊断为 II 期至 III 期浸润性乳腺癌的患者，这些患者在接受确定性乳房手术后接受 NACT，其中 103 例患者纳入最终分析。在 NACT 第 1 周期和第 2 周期前分别测定 DOSI 评估的肿瘤氧合、US 评估的肿瘤体积和多普勒 US 评估的肿瘤血管化。NACT 完成后，患者接受手术，然后进行病理检查和病理肿瘤反应评估。在此基础上，建立数据回归预测模型。
我们在治疗开始后 3 周观察到所有三个参数的变化。然而，仅氧合水平 ΔStO （ρ=0.802，p≤0.01）对早期评估肿瘤对 NACT 的敏感性具有较高的预测潜力。回归模型以高概率正确预测肿瘤反应（89.3%）。“肿瘤体积”模型和“血管化指数”模型不能准确预测肿瘤对治疗无病理反应（分别为 60.9%和 58.7%），而预测阳性反应相对较好（分别为 78.9%和 75.4%）。
漫射光学光谱成像似乎是一种强大的早期预测乳腺癌对化疗反应的工具。它可以帮助确定需要对肿瘤进行额外的分子遗传学研究的患者，以找到治疗耐药的根源，并纠正治疗方案。
