早期乳腺癌患者腋窝淋巴结受累和无病生存与术前 MRI 特征相关。
Preoperative MRI Features Associated With Axillary Nodal Burden and Disease-Free Survival in Patients With Early-Stage Breast Cancer.
机构信息
Cancer Hospital Affiliated to Shanxi Medical University/Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Taiyuan, China.
College of Medical Imaging, Shanxi Medical University, Taiyuan, China.
出版信息
Korean J Radiol. 2024 Sep;25(9):788-797. doi: 10.3348/kjr.2024.0196.
OBJECTIVE
To investigate the potential association among preoperative breast MRI features, axillary nodal burden (ANB), and disease-free survival (DFS) in patients with early-stage breast cancer.
MATERIALS AND METHODS
We retrospectively reviewed 297 patients with early-stage breast cancer (cT1-2N0M0) who underwent preoperative MRI between December 2016 and December 2018. Based on the number of positive axillary lymph nodes (LNs) determined by postoperative pathology, the patients were divided into high nodal burden (HNB; ≥3 positive LNs) and non-HNB (<3 positive LNs) groups. Univariable and multivariable logistic regression analyses were performed to identify independent risk factors associated with ANB. Predictive efficacy was evaluated using the receiver operating characteristic (ROC) curve and area under the curve (AUC). Univariable and multivariable Cox proportional hazards regression analyses were performed to determine preoperative features associated with DFS.
RESULTS
We included 47 and 250 patients in the HNB and non-HNB groups, respectively. Multivariable logistic regression analysis revealed that multifocality/multicentricity (adjusted odds ratio [OR] = 3.905, 95% confidence interval [CI]: 1.685-9.051, = 0.001) and peritumoral edema (adjusted OR = 3.734, 95% CI: 1.644-8.479, = 0.002) were independent risk factors for HNB. Combined peritumoral edema and multifocality/multicentricity achieved an AUC of 0.760 (95% CI: 0.707-0.807) for predicting HNB, with a sensitivity and specificity of 83.0% and 63.2%, respectively. During the median follow-up period of 45 months (range, 5-61 months), 26 cases (8.75%) of breast cancer recurrence were observed. Multivariable Cox proportional hazards regression analysis indicated that younger age (adjusted hazard ratio [HR] = 3.166, 95% CI: 1.200-8.352, = 0.021), larger tumor size (adjusted HR = 4.370, 95% CI: 1.671-11.428, = 0.002), and multifocality/multicentricity (adjusted HR = 5.059, 95% CI: 2.166-11.818, < 0.001) were independently associated with DFS.
CONCLUSION
Preoperative breast MRI features may be associated with ANB and DFS in patients with early-stage breast cancer.
目的
探讨早期乳腺癌患者术前乳腺 MRI 特征、腋窝淋巴结负担（ANB）与无病生存（DFS）之间的潜在关联。
材料与方法
我们回顾性分析了 2016 年 12 月至 2018 年 12 月期间接受术前 MRI 的 297 例早期乳腺癌（cT1-2N0M0）患者。根据术后病理确定的阳性腋窝淋巴结（LNs）数量，患者被分为高淋巴结负担（HNB；≥3 个阳性 LNs）和非 HNB（<3 个阳性 LNs）组。采用单变量和多变量逻辑回归分析确定与 ANB 相关的独立危险因素。采用受试者工作特征（ROC）曲线和曲线下面积（AUC）评估预测效能。采用单变量和多变量 Cox 比例风险回归分析确定与 DFS 相关的术前特征。
结果
我们将 47 例和 250 例患者分别纳入 HNB 和非 HNB 组。多变量逻辑回归分析显示，多灶性/多中心性（调整优势比 [OR] = 3.905，95%置信区间 [CI]：1.685-9.051， = 0.001）和肿瘤周围水肿（调整 OR = 3.734，95% CI：1.644-8.479， = 0.002）是 HNB 的独立危险因素。联合肿瘤周围水肿和多灶性/多中心性预测 HNB 的 AUC 为 0.760（95% CI：0.707-0.807），灵敏度和特异性分别为 83.0%和 63.2%。在中位随访 45 个月（范围，5-61 个月）期间，观察到 26 例（8.75%）乳腺癌复发。多变量 Cox 比例风险回归分析表明，年龄较小（调整风险比 [HR] = 3.166，95% CI：1.200-8.352， = 0.021）、肿瘤较大（调整 HR = 4.370，95% CI：1.671-11.428， = 0.002）和多灶性/多中心性（调整 HR = 5.059，95% CI：2.166-11.818， < 0.001）与 DFS 独立相关。
结论
早期乳腺癌患者术前乳腺 MRI 特征可能与 ANB 和 DFS 相关。
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