多参数MRI联合炎症因子指标对乳腺癌肿瘤浸润淋巴细胞的预测价值  

Predictive Value of Multi-Parameter MRI Combined with Inflammatory Factor Ratio in Breast Cancer Tumor Infiltrating Lymphocytes

作　　者：马红玉 曹琳 刘爽 李建民[1] 赵阳[1] MA Hongyu;CAO Lin;LIU Shuang(Department of Medical Imaging,Second Hospital of Tianjin Medical University,Tianji 300211,P.R.China)

机构地区：[1]天津医科大学第二医院医学影像科,300211 [2]河北省沧州中西医结合医院影像科,061000

出　　处：《临床放射学杂志》2025年第2期259-265,共7页Journal of Clinical Radiology

摘　　要：目的探讨多参数MRI联合外周血炎症因子指标对乳腺癌(BC)肿瘤浸润淋巴细胞(TIL)的预测价值。方法回顾性分析209例经手术病理证实为BC患者的临床、病理及术前影像学资料,根据术后病理结果将其分为TIL低比例组(n=117)和TIL高比例组(n=92),采用Mann-Whitney U检验比较TIL低比例组及TIL高比例组的临床指标、多参数MRI及炎症因子指标的差异,采用多因素Logistic回归分析筛选预测TIL的独立危险因素并构建预测模型。通过绘制受试者工作特征(ROC)曲线和使用曲线下面积(AUC)评价模型的预测效能。结果TIL低比例组及TIL高比例组患者的年龄、月经状态、瘤周水肿、脂肪抑制T_(2)WI信号强度、术前T分期、病理类型、雌激素受体(ER)、孕激素受体(PR)、表皮生长因子受体2(HER-2)均无统计学差异(P>0.05),增殖细胞核抗原(Ki-67)在两组间具有统计学差异(P<0.05)。TIL低比例组及TIL高比例组的MRI参数包括病灶长径、表观扩散系数(ADC)值、脂肪抑制T_(2)WI信号均匀度、K^(trans)及K_(ep)的差异均有统计学意义(P<0.05),TIL低比例组及TIL高比例组的炎症因子指标包括中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、淋巴细胞与单核细胞比值(LMR)、全身免疫炎症指数(SII)、全身炎症反应指数(SIRI)、泛免疫炎症值(PIV)的差异均有统计学意义(P<0.05)。将单因素分析中有统计学意义的指标纳入多因素Logistic回归分析,结果显示K_(ep)、NLR、病灶长径及脂肪抑制T_(2)WI信号均匀度为TIL的独立危险因素。将上述指标构建联合预测模型,结果显示联合预测模型的AUC为0.768、敏感度为80.4%、特异度为58.1%。结论多参数MRI联合外周血炎症因子指标可用于术前对BC TIL的预测,为了解肿瘤免疫微环境及乳腺癌免疫治疗提供个体化指导。Objective To explore the predictive value of multi-parameter MRI combined with peripheral blood inflammatory factor ratio for breast cancer tumor infiltrating lymphocytes.Methods The clinical,pathological and preoperative imaging data of 209 patients with breast cancer confirmed by postoperative pathology were analyzed retrospectively.According to the postoperative pathological results,they were divided into TIL low group(n=117)and TIL high group(n=92).Mann-Whitney U test was used to compare the differences of clinical indexes,multi-parameter MRI and inflammatory factor ratio between the two groups.Multivariate Logistic regression analysis was used to screen the independent risk factors for predicting TIL and establish a prediction model.The level of TIL was predicted by drawing the receiver operating characteristic(ROC)curve evaluation model.Results There was no significant difference in age,menstrual status,peritumoral edema,fat-suppressed T_(2)WI signal intensity,preoperative T staging,pathological type,estrogen receptor status,progesterone receptor status and human epidermal growth factor receptor 2 state between the low and high TIL groups.There was significant difference in proliferation cell nuclear antigen Ki-67 between the two groups(P<0.05).There were significant differences in MRI parameters,including tumor length,ADC value,fat-suppressed T_(2)WI signal homogeneity,K^(trans) and K_(ep) between the low and high TIL groups(P<0.05).The ratios of inflammatory factors between the low and high TIL groups,including neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),lymphocyte to monocyte ratio(LMR),systemic immune inflammation index(SII),systemic inflammatory response index(SIRI)and paninmmune inflammation value(PIV)were significantly different(P<0.05).The statistically significant indexes in univariate analysis were included in multivariate Logistic regression analysis,and the results showed that K_(ep),NLR,tumor length and fat-suppressed T_(2)WI signal homogeneity were independent risk fa

关 键 词：乳腺癌 多参数MRI 肿瘤免疫微环境 肿瘤浸润淋巴细胞 外周血炎症因子指标 

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