乳腺癌患者新辅助化疗病理完全缓解与背景实质强化的相关性

　　乳腺磁共振背景实质强化是在注射对比剂后正常纤维腺体的乳腺磁共振增强，其影响因素主要包括乳腺血供解剖特征和激素对乳腺组织的作用。既往研究发现绝经前乳腺癌患者新辅助治疗前磁共振评估表现为明显背景实质强化，且新辅助治疗后背景实质强化显著降低的患者，更易在新辅助治疗中达到病理完全缓解水平。

　　2017年8月11日，爱思唯尔旗下《转化肿瘤学》在线发表复旦大学附属肿瘤医院和上海医学院、中国科学院上海高等研究院的研究报告，回顾调查了单侧浸润性乳腺癌患者新辅助化疗期间对侧正常乳房多监测点定量背景实质强化，并进一步确定背景实质强化是否与肿瘤缓解有相关性，尤其在新辅助化疗早期阶段。

　　该研究回顾分析了90例术前接受6或8个周期新辅助化疗的单侧乳腺癌患者，分别在基线和第2、4、6个周期新辅助化疗后，测量动态对比增强磁共振的背景实质强化，分析背景实质强化与肿瘤大小的相关性，并分析病理完全缓解与背景实质强化之间的相关性。

　　结果发现，无论绝经状态如何，对侧正常乳房的背景实质强化在整个新辅助化疗期间持续减少（所有P＜0.001）。三个监测点的背景实质强化及其变化均与肿瘤大小显著相关（所有P＜0.05），新辅助化疗第2个周期后背景实质强化减少对病理完全缓解诊断价值最大（曲线下面积：0.726，P＜0.001），尤其激素受体阴性患者（比值比：0.243，95%置信区间：0.083～0.706，P=0.009）。

　　因此，对侧正常乳房的背景实质强化持续减少趋势，与新辅助化疗的肿瘤大小变化相似。新辅助化疗早期背景实质强化减少与病理完全缓解呈正相关性，尤其对于激素受体阴性患者。

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Transl Oncol. 2017 Aug 11;10(5):786-792.

Association Between Background Parenchymal Enhancement and Pathologic Complete Remission Throughout the Neoadjuvant Chemotherapy in Breast Cancer Patients.

You C, Peng W, Zhi W, He M, Liu G, Xie L, Jiang L, Hu X, Shen X, Gu Y.

Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, PR China; Center for Advanced Medical Imaging Technology, Shanghai Advanced Research Institute, Chinese Academy of Sciences, Shanghai, PR China.

PURPOSE: To retrospectively investigate the quantitative background parenchymal enhancement (BPE) of the contralateral normal breast in patients with unilateral invasive breast cancer throughout multiple monitoring points of neoadjuvant chemotherapy (NAC) and to further determine whether BPE is associated with tumor response, especially at the early stage of NAC.

MATERIALS AND METHODS: A total of 90 patients with unilateral breast cancer who then received six or eight cycles of NAC before surgery were analyzed retrospectively. BPE was measured in dynamic contrast-enhanced MRI at baseline and after 2nd, 4th, and 6th NAC, respectively. Correlation between BPE and tumor size was analyzed, and the association between pathologic complete remission (pCR) and BPE was also analyzed.

RESULTS: The BPE of contralateral normal breast showed a constant reduction throughout NAC therapy regardless of the menopausal status (P<.001 in all). Both the BPEs and the changes of BPE in each of the three monitoring points were significantly correlated with those in tumor size (P<.05 in all), and the reduction of BPE after 2nd NAC had the largest diagnostic value for pCR (AUC=0.726, P<.001), particularly in hormonal receptor (HR)-negative patients (OR=0.243, 95%CI=0.083 to 0.706, P=.009).

CONCLUSION: The BPE of contralateral normal breast had a constant decreased tendency similar to the change of tumor size in NAC. Reduction of BPE at the early stage of NAC was positively associated with pCR, especially in HR-negative status.

PMID: 28806712

DOI: 10.1016/j.tranon.2017.07.005