Yi Chunyan, Li Lin, Ma Jie
Department of Radiology, Shenzhen People's Hospital, Shenzhen, China.
Department of Radiology, Cancer Hospital Chinese Academy of Medical Science, Shenzhen Center, Shenzhen, China.
Quant Imaging Med Surg. 2024 Sep 1;14(9):6734-6744. doi: 10.21037/qims-24-447. Epub 2024 Aug 19.
Targeted therapy with neoadjuvant chemotherapy for patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer has increased the rates of pathological complete response (pCR) and breast preservation surgery and improved the overall disease-free survival rate. This study aimed to determine whether tumor enhancement and shrinkage patterns in dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) can predict the efficacy of targeted therapy in patients with HER2-positive breast cancer and differentiate pCR from non-pCR.
The data of 64 patients with HER2-positive breast cancer who received targeted therapy prior to surgery were retrospectively collected. All patients had complete postoperative pathological data. The pretreatment evaluation of the tumor enhancement pattern and the shrinkage pattern after two treatment cycles were assessed. The difference in the enhancement and shrinkage patterns between the pCR and non-pCR groups was evaluated via the χ test. Logistic regression analysis was used to assess the value of enhancement and shrinkage patterns for predicting pCR in patients with HER2-positive breast cancer.
There were statistically significant differences in tumor size, estrogen receptor (ER) status, lymph node metastasis, enhancement pattern, and shrinkage pattern between the pCR and non-pCR cases. Patients with a tumor size ≤20 mm were likely to achieve pCR. ER status, lymph node metastasis, and enhancement and shrinkage patterns each had good precision for predicting pCR, and the combination of enhancement and shrinkage patterns had the highest prediction accuracy. Multivariate logistic regression analysis indicated that only enhancement pattern had a significant predictive value.
Among patients with HER2-positive breast cancer, those with tumor size ≤20 mm, ER-negative status, no lymph node metastases, and mass enhancement and concentric shrinkage patterns are more likely to achieve pCR. Mass enhancement combined with concentric shrinkage had the highest accuracy in predicting pCR, indicating that preoperative imaging may be useful for guiding clinical decisions regarding targeted treatments.
人表皮生长因子受体2（HER2）阳性乳腺癌患者接受新辅助化疗的靶向治疗提高了病理完全缓解（pCR）率和保乳手术率，并改善了总体无病生存率。本研究旨在确定动态对比增强磁共振成像（DCE-MRI）中的肿瘤强化和缩小模式是否能预测HER2阳性乳腺癌患者的靶向治疗疗效，并区分pCR与非pCR。
回顾性收集64例术前接受靶向治疗的HER2阳性乳腺癌患者的数据。所有患者均有完整的术后病理数据。评估肿瘤强化模式的术前评估以及两个治疗周期后的缩小模式。通过χ检验评估pCR组和非pCR组之间强化和缩小模式的差异。采用逻辑回归分析评估强化和缩小模式对预测HER2阳性乳腺癌患者pCR的价值。
pCR病例与非pCR病例在肿瘤大小、雌激素受体（ER）状态、淋巴结转移、强化模式和缩小模式方面存在统计学显著差异。肿瘤大小≤20 mm的患者更有可能实现pCR。ER状态、淋巴结转移以及强化和缩小模式在预测pCR方面均具有良好的准确性，且强化和缩小模式的组合具有最高的预测准确性。多变量逻辑回归分析表明，只有强化模式具有显著的预测价值。
在HER2阳性乳腺癌患者中，肿瘤大小≤20 mm、ER阴性状态、无淋巴结转移以及肿块强化和向心性缩小模式的患者更有可能实现pCR。肿块强化与向心性缩小相结合在预测pCR方面具有最高的准确性，表明术前影像学检查可能有助于指导靶向治疗的临床决策。
