术前乳腺 MRI 对 35 岁及以下女性乳腺癌生存结局的影响。
Effects of Preoperative Breast MRI on Breast Cancer Survival Outcomes in Women Aged 35 Years and Younger.
机构信息
From the Department of Radiology, Research Institute of Radiology (A.R.P., E.Y.C., J.H.C., H.J.S., W.J.C., H.H.K.), and Department of Clinical Epidemiology and Biostatistics (H.J.K.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-Gil, Songpa-Gu, Seoul 05505, South Korea.
出版信息
Radiology. 2023 May;307(4):e221797. doi: 10.1148/radiol.221797. Epub 2023 Mar 28.
Background The impact of preoperative breast MRI on the long-term outcomes in patients with breast cancer who are 35 years and younger has not been established. Purpose To evaluate the impact of preoperative breast MRI on recurrence-free survival (RFS) and overall survival (OS) in women with breast cancer who are 35 years and younger by using propensity score matching. Materials and Methods A total of 708 women who were 35 years and younger (mean age, 32 years ± 3 [SD]) and diagnosed with breast cancer from 2007 to 2016 were retrospectively identified. Patients who underwent preoperative MRI (MRI group) were matched with those who did not (no MRI group) according to 23 patient and tumor characteristics. RFS and OS were compared using the Kaplan-Meier method. Cox proportional hazards regression analysis was used to estimate the hazard ratios (HRs). Results Of 708 women, 125 patient pairs were matched. In the MRI group versus the no MRI group, the mean follow-up time was 82 months ± 32 versus 106 months ± 42, and the rates of total recurrence and death were 22% (104 of 478 patients) versus 29% (66 of 230 patients) and 5% (25 of 478 patients) versus 12% (28 of 230 patients), respectively. The time to recurrence was 44 months ± 33 in the MRI group and 56 months ± 42 in the no MRI group. After propensity score matching, the MRI and no MRI groups did not show significant differences in total recurrence (HR, 1.0; = .99), local-regional recurrence (HR, 1.3; = .42), contralateral breast recurrence (HR, 0.7; = .39), or distant recurrence (HR, 0.9; = .79). The MRI group showed a tendency toward better OS, but this was not statistically significant (HR, 0.47; = .07). In the entire unmatched cohort, MRI was not an independent significant factor for predicting RFS or OS. Conclusion Preoperative breast MRI was not a significant prognostic factor for recurrence-free survival in women 35 years and younger with breast cancer. A tendency toward better overall survival was observed in the MRI group, but this was not significant. © RSNA, 2023 See also the editorial by Kim and Moy in this issue.
背景 术前乳腺 MRI 对 35 岁及以下乳腺癌患者的长期预后的影响尚未确定。目的 通过倾向评分匹配，评估术前乳腺 MRI 对 35 岁及以下乳腺癌患者无复发生存率（RFS）和总生存率（OS）的影响。材料与方法 回顾性分析 2007 年至 2016 年间诊断为乳腺癌且年龄为 35 岁及以下的 708 例女性患者的资料，这些患者的平均年龄为 32 岁±3（标准差[SD]）。根据 23 项患者和肿瘤特征，将接受术前 MRI（MRI 组）的患者与未接受 MRI 的患者（无 MRI 组）进行匹配。使用 Kaplan-Meier 法比较 RFS 和 OS。采用 Cox 比例风险回归分析估计风险比（HR）。结果 在 708 例女性患者中，有 125 对患者匹配成功。在 MRI 组与无 MRI 组中，平均随访时间分别为 82 个月±32 和 106 个月±42，总复发率和死亡率分别为 22%（478 例患者中的 104 例）和 29%（230 例患者中的 66 例）、5%（478 例患者中的 25 例）和 12%（230 例患者中的 28 例）。MRI 组的复发时间为 44 个月±33，无 MRI 组的复发时间为 56 个月±42。在进行倾向评分匹配后，MRI 组与无 MRI 组在总复发（HR，1.0； =.99）、局部-区域复发（HR，1.3； =.42）、对侧乳房复发（HR，0.7； =.39）或远处复发（HR，0.9； =.79）方面均无显著差异。MRI 组的 OS 有改善的趋势，但无统计学意义（HR，0.47； =.07）。在整个未匹配队列中，MRI 不是预测 RFS 或 OS 的独立显著因素。结论 对于 35 岁及以下的乳腺癌患者，术前乳腺 MRI 不是无复发生存率的显著预后因素。在 MRI 组中观察到总生存率有改善的趋势，但无统计学意义。©RSNA，2023 本期杂志还包含 Kim 和 Moy 的社论。
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