MRI多参数成像联合临床和病理预测HER-2阳性乳腺癌双靶治疗疗效的价值  

Value of MRI Multi-Parameter Imaging Combined with Clinical and Pathological in Predicting the Efficacy of Dual-Target Therapy for HER-2 Positive Breast Cancer

作　　者：吴兰 林天诚 符天旭 罗是是[1] 王振平 WU Lan;LIN Tiancheng;FU Tianxu(Department of Radiology,Hainan General Hospital(Hainan Affiliated Hospital of Hainan Medical University),Haikou,Hainan Province 570311,P.R.China)

机构地区：[1]海南省人民医院(海南医科大学附属海南医院)放射科,海口570311 [2]广东省中医院海南医院(海南省中医院)放射科,海口570203

出　　处：《临床放射学杂志》2025年第2期243-248,共6页Journal of Clinical Radiology

基　　金：海南省高等学校科学研究资助项目(编号:Hnky2020-41);海南省自然科学基金面上项目(编号:820MS132);海南省自然科学基金高层次人才项目(编号:821RC677);海南省临床医学中心建设项目。

摘　　要：目的探讨多参数MRI对人表皮生长因子受体-2(HER-2)阳性乳腺癌新辅助治疗(NAT)(双靶向治疗+序贯化疗)疗效预测的价值。方法回顾性分析病理确诊为HER-2阳性乳腺癌并接受NAT(双靶向治疗+序贯化疗)的患者68例,治疗前均已行MRI平扫及动态增强扫描。术后病理诊断分为病理完全缓解(pCR)组及非病理完全缓解(non-pCR)组,对比两组间发病年龄、病理类型、组织学分级、分子分型[激素受体(HR)表达状态]、细胞核增殖指数(Ki-67)、肿瘤最大径、时间-信号强度曲线(TIC)、纤维腺体组织、背景实质强化(BPE)、强化方式以及乳腺水肿评分(BES)等指标差异,筛选出能预测NAT疗效的参数,评价其预测NAT疗效(pCR)的诊断效能。结果68例中pCR组44例(64.7%),non-pCR组24例(35.3%)。pCR组与non-pCR组分子分型(HR表达状态)、肿瘤直径、BPE、BES差异具有统计学意义(P<0.05);Logistic回归分析显示分子分型(HR表达状态)、BPE、BES是HER-2阳性乳腺癌双靶治疗后达到pCR的独立预测因素,其预测NAT疗效效能的曲线下面积(AUC)值分别为0.649、0.810、0.723,三者联合预测AUC值为0.892,敏感度为79.17%、特异度为86.36%。结论HER-2阳性乳腺癌患者NAT(双靶向治疗+序贯化疗)后pCR组与non-pCR组的分子分型(HR表达状态)、肿瘤最大直径、BES、BPE差异可作为双靶治疗后达到pCR的独立预测因子,且三者联合时效能最佳。Objective To investigate the value of multi-parameter MRI in predicting the efficacy of neoadjuvant therapy(dual-targeted therapy and sequential chemotherapy)for HER-2 positive breast cancer.Methods Retrospective analysis was performed involving 68 patients with breast cancer diagnosed as HER-2 positive and receiving neoadjuvant therapy(dual-targeted therapy and sequential chemotherapy).Before treatment,MRI plain scan and dynamic enhancement were performed.The patients were divided into pathological complete response(pCR)group and non-pCR group.The differences in age,pathological type,histological grading,molecular typing(HR expression status),nuclear proliferation index Ki-67,tumor maximum diameter,time signal intensity curve(TIC),fibroglandular tissue(FGT),background parenchymal enhancement(BPE),enhancement mode,and breast edema score(BES)were compared between the two groups to screen parameters that can predict the efficacy of NAT and evaluate their diagnostic efficacy in predicting pCR efficacy.Results A total of 68 patients were eligible for enrollment and grouped according to the therapeutic effect,44 patients(64.7%)in the pCR group and 24 patients(35.2%)in the non-pCR group.The differences in molecular typing(hormone expression status),tumor diameter,BPE,and BES between the pCR group and the non-pCR group were statistically significant(P<0.05).Molecular typing(hormone expression status),BPE,and BES were independent predictors of achieving pCR after dual-targeted treatment for HER-2 positive breast cancer.The AUC values of molecular typing(hormone expression status),BPE and BES were 0.649,0.810,and 0.723,respectively,and the combined prediction of the three had an AUC value of 0.892,with a sensitivity of 79.17%and a specificity of 86.36%.Conclusion Molecular typing(hormone expression status),BPE and BES could be used as independent predictors of achieving pCR after dual-targeted therapy for HER-2 positive breast cancer,and the best efficacy was achieved when all three were combined.

关 键 词：乳腺癌 新辅助治疗 磁共振成像 乳腺水肿 背景实质强化 

分 类 号：R737.9[医药卫生—肿瘤] R445.2[医药卫生—临床医学]