利用1H—MRS早期评估乳腺癌新辅助化疗疗效的研究  

1H-MRS ：A useful method to evaluate the early response of breast cancer to neoadjuvant chemotherapy

作　　者：陆旭[1] 华彬[1] 姜蕾[1] 戴维德[1] 肖文政[1] 李波[1] 

机构地区：[1]卫生部北京医院,北京100730

出　　处：《中国医刊》2012年第12期35-37,共3页Chinese Journal of Medicine

摘　　要：目的探讨利用氢质子磁共振波谱（1H—MRS）检测肿瘤组织的复合胆碱（tCho）浓度，早期评估乳腺癌新辅助化疗疗效的价值。方法对72例拟行新辅助化疗的乳腺癌患者（肿瘤T分期在T1C以上），在化疗前1周内及化疗第1疗程结束后2周内各进行1次乳腺MRI（包括。H—MRS）及超声检查。所有患者化疗前均经组织学穿刺活检确诊，在新辅助化疗疗程结束后均进行手术治疗。将手术病理切片与化疗前穿刺病理片比较，将患者分为有显著疗效组和无显著疗效组。采用受试者工作特性曲线（ROC）确定以化疗前后tCho浓度变化判断化疗效果的最佳界值，并比较以tCho浓度下降值判断化疗效果与病理学评价结果的一致性。结果72例患者中，有显著疗效64例，无显著疗效8例。有显著疗效组化疗前、后tCho浓度分别为（4．55±2．75）mmol／L和（1．06±1．32）mmol／L，差异有统计学意义（P〈0．01）；而无显著疗效组为（4．61±2．57）mmol／L和（3．72±2．20）mmol／L，差异无统计学意义（P〉0．05）。两组MRI及超声测量病灶大小在化疗前后差异均无统计学意义（均P〉0．05）。ROC曲线分析结果显示，tCho浓度降低1．39mmol／L时，判断效果最好，曲线下面积为0．980，灵敏度为0．969，特异度为0．875。72例患者中，有显著疗效62例，无显著疗效10例，与病理学评价结果有较好的一致性，Kappa=0．746（P〈0．001）。结论在新辅助化疗早期，利用1H—MRS检测化疗前后tCho浓度的变化可以评估化疗的疗效，而MRI及超声检查测量病灶大小的变化不能有效评估化疗的疗效。Objective To evaluate the significance of MRI （including 1H-MRS） and ultrasoundgraphy in monitoring the early response of breast cancer to neoadjuvant chemotherapy （NCT）. Methods Seventy-two patients with breast cancer received NCT （tumor size〉Tic） and surgery. Before NCT, all patients were diagnosed by histologic patholo- gy. Within one week before NCT and 2 weeks after the first NCT, all candidates took MRI （including 1H-MRS） and ultrasoundgraphy respectively. By analyzing the difference of histology from surgery, candidates were divided in- to significant responder group （ R group） and non-significant responder group （ NR group）. The optimum cutoff of tCho concentration change to evaluate the NCT response was determined by ROC and tCho concentration changes were compared with the pathologic diagnosis. Results Among 72 cases, 64 were belong to R group,8 to NR group. TCho concentrations tested by IH-MRS were （4.55±2.75） mmol/L, （1.06±1.32） mmol/L before NCT and after NCT in R group,decreased signicantly （t = 8. 569, P〈0.01 ）. In the NR group, tCho concentrations were （4.61＋ 2.57） mmol/L and （3.72±2.20）mmol/L respectively before and after NCT and the parameters had no significant change（t=0. 913, P〉0.05）. By ROC, the decreased concentration of tCho to 1.39 mmol/L was the best cutoff to determine of NCT response. The area under ROC was 0. 980, the sensitivity was 0. 969 and the specificity was 0. 875. By the cutoff ,among 72 cases, 62 were belong to R group, 10 to NR group. The results were comparable with the pathologic diagnosis, Kappa = 0. 746 （P〈0. 001 ）. There were not significant changes about the sizes of tumors tested by MRI and uhrasoundgraphy before and after NCT. Conclusions In the early stage of NCT, 1 H-MRS can predict the response of tumor to NCT by the metabolic change ; While the size of tumor change little by MRI and uhrasoundgraphy and has no meanings in predicting the NCT response.

关 键 词：乳腺肿瘤 新辅助化疗 氢质子磁共振波谱 磁共振成像 超声检查 

分 类 号：R739.5[医药卫生—肿瘤]