局部晚期乳腺癌的应变超声弹性成像特征：与新辅助化疗反应和无复发生存率的关系。
Strain ultrasonic elastography imaging features of locally advanced breast cancer: association with response to neoadjuvant chemotherapy and recurrence-free survival.
机构信息
Department of Breast Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Pujian Rd, Shanghai, 200127, China.
Department of Ultrasound, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Pujian Rd, Shanghai, 200127, China.
出版信息
BMC Med Imaging. 2023 Dec 21;23(1):216. doi: 10.1186/s12880-023-01168-2.
BACKGROUND
Due to the highly heterogeneity of the breast cancer, it would be desirable to obtain a non-invasive method to early predict the treatment response and survival outcome of the locally advanced breast cancer (LABC) patients undergoing neoadjuvant chemotherapy (NAC). This study aimed at investigating whether strain elastography (SE) can early predict the pathologic complete response (pCR) and recurrence-free survival (RFS) in LABC patients receiving NAC.
METHODS
In this single-center retrospective study, 122 consecutive women with LABC who underwent SE examination pre-NAC and after one and two cycles of NAC enrolled in the SHPD001(NCT02199418) and SHPD002 (NCT02221999) trials between January 2014 and August 2017 were included. The SE parameters (Elasticity score, ES; Strain ratio, SR; Hardness percentage, HP, and Area ratio, AR) before and during NAC were assessed. The relative changes in SE parameters after one and two cycles of NAC were describe as ΔA and ΔA, respectively. Logistic regression analysis and Cox proportional hazards model were used to identify independent variables associated with pCR and RFS.
RESULTS
Forty-nine (40.2%) of the 122 patients experienced pCR. After 2 cycles of NAC, SR (odds ratio [OR], 1.502; P = 0.003) and ΔSR (OR, 0.013; P = 0.015) were independently associated with pCR, and the area under the receiver operating characteristic curve for the combination of them to predict pCR was 0.855 (95%CI: 0.779, 0.912). Eighteen (14.8%) recurrences developed at a median follow-up of 60.7 months. A higher clinical T stage (hazard ratio [HR] = 4.165; P = 0.005.), a higher SR (HR = 1.114; P = 0.002.) and AR (HR = 1.064; P < 0.001.) values at pre-NAC SE imaging were independently associated with poorer RFS.
CONCLUSION
SE imaging features have the potential to early predict pCR and RFS in LABC patients undergoing NAC, and then may offer valuable predictive information to guide personalized treatment.
背景
由于乳腺癌具有高度异质性，因此人们希望获得一种非侵入性的方法，以便能够早期预测接受新辅助化疗（NAC）的局部晚期乳腺癌（LABC）患者的治疗反应和生存结局。本研究旨在探讨应变弹性成像（SE）是否可以早期预测接受 NAC 的 LABC 患者的病理完全缓解（pCR）和无复发生存（RFS）。
方法
在这项单中心回顾性研究中，共纳入了 2014 年 1 月至 2017 年 8 月期间在 SHPD001（NCT02199418）和 SHPD002（NCT02221999）试验中接受 SE 检查的 122 例 LABC 连续女性患者，这些患者在 NAC 前和 NAC 期间接受了 SE 检查。评估了 NAC 前后 SE 参数（弹性评分 ES、应变比 SR、硬度百分比 HP 和面积比 AR）。分别描述 NAC 后一个和两个周期后的 SE 参数的相对变化ΔA 和ΔA。使用逻辑回归分析和 Cox 比例风险模型来确定与 pCR 和 RFS 相关的独立变量。
结果
122 例患者中有 49 例（40.2%）经历了 pCR。在接受 2 个周期的 NAC 后，SR（比值比 [OR]，1.502；P=0.003）和ΔSR（OR，0.013；P=0.015）与 pCR 独立相关，二者联合预测 pCR 的受试者工作特征曲线下面积为 0.855（95%CI：0.779，0.912）。在中位随访 60.7 个月时，18 例（14.8%）发生了复发。在 NAC 前 SE 成像中，较高的临床 T 分期（HR=4.165；P=0.005）、较高的 SR（HR=1.114；P=0.002）和 AR（HR=1.064；P<0.001）值与较差的 RFS 独立相关。
结论
SE 成像特征有可能早期预测接受 NAC 的 LABC 患者的 pCR 和 RFS，然后可能为指导个性化治疗提供有价值的预测信息。
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