Shanghai Institute of Medical Imaging, Shanghai 200032, China; Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.
Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.
Clin Radiol. 2024 Aug;79(8):e1010-e1020. doi: 10.1016/j.crad.2024.04.021. Epub 2024 May 14.
To explore the independent and additional value of oedema and shrinkage patterns for predicting the disease-free survival (DFS) and neoadjuvant chemotherapy (NAC) response in luminal breast cancer (BC).
Patients with luminal BC who underwent NAC were enrolled in this study from 2017 to 2022. Traditional MRI features include BI-RADS-based MRI descriptors, tumor size, and ADC values, while emerging MRI features include oedema and shrinkage patterns, all of which were evaluated before, early, and after NAC. The changes in features during NAC were also evaluated. The value of features was evaluated through univariate, multivariate analyses.
A total of 258 patients were enrolled in this study, of which 77 responded to NAC. Diffuse oedema, stable or increased oedema during early NAC were adverse predictors for treatment response, while a greater reduction in tumor size and increase in ADC value were favorable predictors (all P<0.05). Furthermore, 20 of 60 patients who were followed up experienced recurrence. Diffuse oedema, pre-pectoral or subcutaneous oedema, and non-concentric shrinkage patterns after NAC were risk factors for DFS, whereas a greater increase in ADC value was a protective factor. Incorporating oedema and shrinkage patterns into traditional MRI features improved the predictive performance for treatment response (AUC from 0.76-0.78 to 0.80-0.83) and DFS (C-index from 0.67-69 to 0.75-0.80).
Oedema is an unfavorable predictor for treatment response and survival outcomes, while shrinkage patterns contribute more to the prognostic value, both of which could offer supplementary benefits for clinical outcomes in luminal BC.
探索水肿和收缩模式对预测 luminal 乳腺癌（BC）无病生存（DFS）和新辅助化疗（NAC）反应的独立和附加价值。
本研究纳入了 2017 年至 2022 年间接受 NAC 的 luminal BC 患者。传统 MRI 特征包括基于 BI-RADS 的 MRI 描述符、肿瘤大小和 ADC 值，而新兴 MRI 特征包括水肿和收缩模式，这些特征均在 NAC 前、早期和晚期进行评估。还评估了 NAC 期间特征的变化。通过单变量、多变量分析评估特征的价值。
本研究共纳入 258 例患者，其中 77 例对 NAC 有反应。弥漫性水肿、早期 NAC 中稳定或增加的水肿是治疗反应的不良预测因素，而肿瘤大小的更大减小和 ADC 值的增加是有利的预测因素（均 P<0.05）。此外，在 60 例随访的患者中有 20 例复发。NAC 后弥漫性水肿、胸肌前或皮下水肿、非同心性收缩模式是 DFS 的危险因素，而 ADC 值的更大增加是保护因素。将水肿和收缩模式纳入传统 MRI 特征可提高治疗反应（AUC 从 0.76-0.78 提高至 0.80-0.83）和 DFS（C 指数从 0.67-0.69 提高至 0.75-0.80）的预测性能。
水肿是治疗反应和生存结局的不利预测因素，而收缩模式对预后价值的贡献更大，两者均可为 luminal BC 的临床结局提供补充益处。
