Department of Radiology, Seoul National University Hospital, Seoul, Korea.
Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
Korean J Radiol. 2023 Jul;24(7):626-639. doi: 10.3348/kjr.2022.0974.
To investigate the association of clinical, pathologic, and magnetic resonance imaging (MRI) variables with progressive disease (PD) during neoadjuvant chemotherapy (NAC) and distant metastasis-free survival (DMFS) in patients with triple-negative breast cancer (TNBC).
This single-center retrospective study included 252 women with TNBC who underwent NAC between 2010 and 2019. Clinical, pathologic, and treatment data were collected. Two radiologists analyzed the pre-NAC MRI. After random allocation to the development and validation sets in a 2:1 ratio, we developed models to predict PD and DMFS using logistic regression and Cox proportional hazard regression, respectively, and validated them.
Among the 252 patients (age, 48.3 ± 10.7 years; 168 in the development set; 84 in the validation set), PD was occurred in 17 patients and 9 patients in the development and validation sets, respectively. In the clinical-pathologic-MRI model, the metaplastic histology (odds ratio [OR], 8.0; = 0.032), Ki-67 index (OR, 1.02; = 0.044), and subcutaneous edema (OR, 30.6; = 0.004) were independently associated with PD in the development set. The clinical-pathologic-MRI model showed a higher area under the receiver-operating characteristic curve (AUC) than the clinical-pathologic model (AUC: 0.69 vs. 0.54; = 0.017) for predicting PD in the validation set. Distant metastases occurred in 49 patients and 18 patients in the development and validation sets, respectively. Residual disease in both the breast and lymph nodes (hazard ratio [HR], 6.0; = 0.005) and the presence of lymphovascular invasion (HR, 3.3; < 0.001) were independently associated with DMFS. The model consisting of these pathologic variables showed a Harrell's C-index of 0.86 in the validation set.
The clinical-pathologic-MRI model, which considered subcutaneous edema observed using MRI, performed better than the clinical-pathologic model for predicting PD. However, MRI did not independently contribute to the prediction of DMFS.
探讨新辅助化疗（NAC）期间临床、病理和磁共振成像（MRI）变量与三阴性乳腺癌（TNBC）患者进展性疾病（PD）和无远处转移生存（DMFS）的相关性。
本单中心回顾性研究纳入了 2010 年至 2019 年间接受 NAC 的 252 例 TNBC 患者。收集了临床、病理和治疗数据。两名放射科医生分析了 NAC 前的 MRI。按 2:1 的比例随机分配到开发集和验证集后，我们分别使用逻辑回归和 Cox 比例风险回归建立预测 PD 和 DMFS 的模型，并对其进行验证。
在 252 例患者（年龄 48.3±10.7 岁；168 例在开发集，84 例在验证集）中，有 17 例患者在开发集和验证集中发生了 PD。在临床-病理-MRI 模型中，间变性组织学（比值比 [OR]，8.0； = 0.032）、Ki-67 指数（OR，1.02； = 0.044）和皮下水肿（OR，30.6； = 0.004）与开发集中的 PD 独立相关。临床-病理-MRI 模型在验证集中预测 PD 的受试者工作特征曲线下面积（AUC）高于临床-病理模型（AUC：0.69 比 0.54； = 0.017）。在开发集和验证集中，远处转移分别发生在 49 例和 18 例患者中。乳腺和淋巴结残留疾病（风险比 [HR]，6.0； = 0.005）和淋巴管浸润（HR，3.3； < 0.001）与 DMFS 独立相关。验证集中包含这些病理变量的模型显示 Harrell's C 指数为 0.86。
考虑到 MRI 观察到的皮下水肿的临床-病理-MRI 模型在预测 PD 方面优于临床-病理模型。然而，MRI 并不能独立预测 DMFS。
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