术前磁共振成像对HER2阳性且激素受体阴性乳腺癌患者生存结局的影响
Impact of Preoperative MRI on Survival Outcomes in Patients with HER2-positive and Hormone Receptor-negative Breast Cancer.
作者信息
Kim Hee Jeong, Choi Woo Jung, Eom Hye Joung, Chae Eun Young, Shin Hee Jung, Cha Joo Hee, Kim Hak Hee
机构信息
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea.
出版信息
Radiology. 2025 Apr;315(1):e242712. doi: 10.1148/radiol.242712.
Background Little is known regarding the impact of preoperative breast MRI on the long-term outcomes of patients with breast cancer that is human epidermal growth factor receptor 2 (HER2) positive and hormone receptor negative. Purpose To evaluate the impact of preoperative breast MRI on recurrence-free survival (RFS) and overall survival (OS) in patients with HER2-positive and hormone receptor-negative breast cancer by using propensity score matching. Materials and Methods This retrospective study included women diagnosed with HER2-positive and hormone receptor-negative invasive ductal carcinoma between January 2007 and December 2016. Patients who underwent preoperative MRI (the MRI group) were matched with those who did not (the no-MRI group) using propensity score matching based on 19 clinical-pathologic covariates. RFS and OS were compared using Kaplan-Meier estimates, Cox proportional hazards models, and inverse probability weighting. Results Among 1094 women (median age, 52 years; age range, 24-91 years), 47.81% (523 of 1094) underwent preoperative MRI. The rates of total recurrence and death were 14.3% (75 of 523) and 7.07% (37 of 523) in the MRI group, respectively, compared with 16.5% (94 of 571) and 13.1% (75 of 571) in the no-MRI group. In the propensity score-matched set, preoperative MRI was not associated with total recurrence (hazard ratio [HR], 0.69; 95% CI: 0.47, 1.02; = .06), local-regional recurrence (HR, 0.94; 95% CI: 0.52, 1.70; = .84), contralateral breast recurrence (HR, 0.55; 95% CI: 0.24, 1.25; = .15), or distant recurrence (HR, 0.56; 95% CI: 0.31, 1.03; = .06). OS was not higher with preoperative MRI (HR, 0.63; 95% CI: 0.39, 1.00; = .05). At multivariable analysis, preoperative MRI was not associated with improved RFS (HR, 0.89; 95% CI: 0.67, 1.19; = .44) or OS (HR, 0.73; 95% CI: 0.48, 1.10; = .14). Conclusion Preoperative MRI did not improve RFS or OS in patients with HER2-positive and hormone receptor-negative breast cancer. © RSNA, 2025 See also the editorial by Imbriaco and Ponsiglione in this issue.
背景
关于术前乳腺磁共振成像（MRI）对人表皮生长因子受体2（HER2）阳性且激素受体阴性乳腺癌患者长期预后的影响，目前所知甚少。目的：通过倾向评分匹配法评估术前乳腺MRI对HER2阳性且激素受体阴性乳腺癌患者无复发生存期（RFS）和总生存期（OS）的影响。材料与方法：这项回顾性研究纳入了2007年1月至2016年12月期间诊断为HER2阳性且激素受体阴性浸润性导管癌的女性患者。根据19个临床病理协变量，采用倾向评分匹配法将接受术前MRI检查的患者（MRI组）与未接受术前MRI检查的患者（非MRI组）进行匹配。采用Kaplan-Meier估计法、Cox比例风险模型和逆概率加权法比较RFS和OS。结果：在1094名女性患者中（中位年龄52岁；年龄范围24 - 91岁），47.81%（1094例中的523例）接受了术前MRI检查。MRI组的总复发率和死亡率分别为14.3%（523例中的75例）和7.07%（523例中的37例），而非MRI组分别为16.5%（571例中的94例）和13.1%（571例中的75例）。在倾向评分匹配组中，术前MRI与总复发（风险比[HR]，0.69；95%可信区间：0.47，1.02；P = 0.06）、局部区域复发（HR，0.94；95%可信区间：0.52，1.70；P = 0.84）、对侧乳腺复发（HR，0.55；95%可信区间：0.24，1.25；P = 0.15）或远处复发（HR，0.56；95%可信区间：0.31，1.03；P = 0.06）均无关联。术前MRI检查的患者OS也没有更高（HR，0.63；95%可信区间：0.39，1.00；P = 0.05）。在多变量分析中，术前MRI与改善RFS（HR，0.89；95%可信区间：0.67，1.19；P = 0.44）或OS（HR，0.73；95%可信区间：0.48，1.10；P = 0.14）均无关联。结论：术前MRI并未改善HER2阳性且激素受体阴性乳腺癌患者的RFS或OS。© RSNA，2025 另见本期Imbriaco和Ponsiglione的社论。
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