MRI对局部进展期乳腺癌新辅助化疗早期疗效评价

摘要

目的 采用磁共振扩散加权成像(DWI)表观扩散系数(ADC)评价局部进展期乳腺癌(LABC)新辅助化疗(NCT)的早期疗效.资料与方法 32例LABC患者采用多西紫杉醇联合表柔比星(75mg/m2静脉推注,第1天给药,3周方案)进行NCT治疗.每21d为1个周期,至肿瘤缩小到可手术或保乳手术可行时停止化疗.于化疗前、化疗1个周期后和手术前行DWI扫描,分析肿瘤体积、ADC值变化及其相关性.结果 20例(62.5％,95％ CI 45.7％～79.3％)患者行2个周期化疗后出现整体有效(OR),临床完全缓解(cCR)率及病理完全缓解(pCR)率分别为156％ (5/32)和9.4％ (3/32):疾病稳定(cSD)率为34.4％ (11/32),疾病进展(cPD)率为3.1％ (1/32);第1个NCT后,cCR+部分缓解(cPR)组AD)C值显著增加[化疗前ADC值为(0.98±0.16)×103mm2/s,化疗后为( 1.22±026)×103mm2/s] (P＜ 0.001).化疗前cCR+cPR组初始ADC值显著低于cSD+cPD组[(1.13±0.06)×10-3mm2/s](P＜0.001).初始ADC值与化疗后肿瘤体积变化呈负相关(r=-0.58,P=0.02)；化疗后肿瘤ADC值与肿瘤体积变化呈正相关(r=096,P＜0.001).结论 乳腺癌病灶初始ADC值及NCT后早期ADC值变化可以作为预测乳腺癌对NCT敏感性和化疗早期评价乳腺癌敏感性的指标.%Purpose To evaluate the early effect of neoadjuvant chemotherapy (NCT) on locally advanced breast carcinoma (LABC) by using the apparent diffusion coefficient (ADC) value of DWI. Materials and Methods Thirty-two patients with LABC undertook NCT (Docetaxel and Epirubicin, intravenously injected 75mg/m2, day 1, 21 days as a cycle) till patients were suitable for surgery or breast-conserving therapy according to the tumor size. DWI scan was performed one week before chemotherapy, after the first cycle of treatment, and before surgery, respectively. Changes of tumor volumes and tumor ADC values were recorded, and their correlation was analyzed. Results The overall response (OR) was obtained in 20 patients (62.5%, 95% CI, 45.7%-79.3%) after 2 cycles of NCT. The clinical complete remission (cCR) rate and pathological CR (pCR) rate were 15.6% (5/32) and 9.4% (3/32), respectively. The stable disease (cSD) rate and progressive disease (cPD) rate were 34.4% (11/32) and (3.1%, 1/32), respectively. After one cycle of NCT, the ADC values in the cCR+cPR group were significantly increased [the ADC value was (0.98±0.16)X lO'mmVs before NCT and (1.22+0.26)× 10-3mm2/s after NCT] (P < 0.001). The initial ADC values before chemotherapy in the OR group were significantly lower than those in cSD+cPD group (P < 0.001). The initial ADC value showed a negative correlation with the change of tumor volume (r =-0.5S, P = 0.02). The change of ADC value of tumors after chemotherapy snowed a positive correlation with the change of tumor volume (r = 0.96, P < 0.001). Conclusion The initial ADC value and the change of ADC value in the early stage after NCT can predict the sensitivity of NCT to breast cancer, which can be regarded as a sensitive marker of breast cancer in the early stage of chemotherapy.