动态增强MRI 对乳腺癌患者术前化疗疗效评价及相关因素分析:附31 例报道

doi:10.3877/cma.j.issn.1674-0807.2011.03.004

目的

探讨动态增强MRI(dynamic contrast-enhanced MRI)对乳腺癌术前化疗疗效评价的价值,并对近期疗效相关因素进行分析。

方法

选择2010 年1 月至2010 年8 月本院收治的新发乳腺癌患者中接受术前化疗并已行手术获得组织病理学评价的31 例患者为研究对象。术前化疗方案以蒽环类及紫杉类细胞毒药物为基础,对HER-2 阳性患者联合应用曲妥珠单克隆抗体,参照实体肿瘤疗效评价标准(RECIST 1.1)及组织学分级系统(Miller and Payne grading system)对术前化疗疗效进行综合评价。

结果

31 例患者中MRI 影像学评价完全缓解(CR)5 例(16.1%),部分缓解(PR)23 例(74.2%),疾病稳定(SD)2 例(6.5%),疾病进展(PD)1 例(3.2%);组织分级系统评价13 例G5(42.0%),5 例G4(16.1%),8 例G3(25.8%),4 例G2(12.9%),1 例G1(3.2%)。

结论

对于符合适应证的乳腺癌患者,个体化选择术前化疗可以使其获益;动态增强MRI 对乳腺癌术前化疗疗效的评价与组织病理评价有一定的关系。

关键词: 乳腺肿瘤, 术前化疗, 动态增强MRI

Objective

To investigate dynamic contrast-enhanced MRI evaluation on the therapeutic effect of preoperative chemotherapy in breast cancer patients and to analysis related factors of short-term therapy effect.

Methods

The study subjects included 31 patients who had received preoperative chemotherapy for primary breast cancer in our department from January 2010 to August 2010. The preoperative chemotherapy regimens were based on anthracyclines and taxanes; and trastuzumab was added for HER-2 positive patients. Response Evaluation Criteria in Solid Tumors (RECIST) and Miller and Payne grading system were used to evaluate the response of preoperative chemotherapy.

Results

Among the 31 patients, 5(16.1%)patients had complete response (CR), 23(74.2%)patients had partial response (PR), 2(6.5%)patients obtained stable disease (SD) and 1(3.2%)patient obtained progressive disease (PD) according to the MRI evaluation. According to the Miller and Payne grading system, 13(42.0%) patients had G5,5(16.1%) patients G4,8 (25.8%)patients G3,4 (12.9%)patients G2,and 1 (3. 2%) patients G1.

Conclusions

Individualized preoperative chemotherapy treatment can benefit patients with indications. Dynamic enhanced MRI evaluation on the therapeutic effect of preoperative chemotherapy in breast cancer has certain relation with histopathological evaluation.

Key words: breast neoplasms, preoperative chemotherapy, dynamic enhanced MRI

表1 Miller-Payne 分级标准

病理分级	分级标准
1级(G1)	个别癌细胞有变化,但总数未减少
2级(G2)	癌细胞少量减少,但总数量级仍高,减少不足30%
3级(G3)	癌细胞中度减少,减少30%以上,最高可减少达90%
4级(G4)	癌细胞显著减少,仅见分散的细胞簇;减少90%以上
5级(G5)	原肿瘤部位已无癌细胞

表1 Miller-Payne 分级标准

病理分级	分级标准
1级(G1)	个别癌细胞有变化,但总数未减少
2级(G2)	癌细胞少量减少,但总数量级仍高,减少不足30%
3级(G3)	癌细胞中度减少,减少30%以上,最高可减少达90%
4级(G4)	癌细胞显著减少,仅见分散的细胞簇;减少90%以上
5级(G5)	原肿瘤部位已无癌细胞

表2 31 例患者的治疗前资料

临床资料	病例数(%)
年龄
≤50岁	19(61.3)
＞50岁	12(38.7)
月经状态
绝经前	20(64.5)
绝经后	11(35.5)
临床分期
II期	18(58.1)
III期	13(41.9)
浸润癌类型
导管癌	31(100.0)
小叶癌	0(0.0)
组织学分级
I级	4(12.9)
II级	12(38.7)
III级	15(48.4)
ER
阳性	16(51.6)
阴性	15(48.4)
PR
阳性	12(38.7)
阴性	19(61.3)
HER-2
阳性	13(41.9)
阴性	18(58.1)
Ki67
≥10%	29(93.5)
＜10%	2(6.5)
P53
-	13(41.9)
+	3(9.7)
++	3(9.7)
+++	12(38.7)

表2 31 例患者的治疗前资料

临床资料	病例数(%)
年龄
≤50岁	19(61.3)
＞50岁	12(38.7)
月经状态
绝经前	20(64.5)
绝经后	11(35.5)
临床分期
II期	18(58.1)
III期	13(41.9)
浸润癌类型
导管癌	31(100.0)
小叶癌	0(0.0)
组织学分级
I级	4(12.9)
II级	12(38.7)
III级	15(48.4)
ER
阳性	16(51.6)
阴性	15(48.4)
PR
阳性	12(38.7)
阴性	19(61.3)
HER-2
阳性	13(41.9)
阴性	18(58.1)
Ki67
≥10%	29(93.5)
＜10%	2(6.5)
P53
-	13(41.9)
+	3(9.7)
++	3(9.7)
+++	12(38.7)

表3 31 例乳腺癌患者的术前化疗方案 [例(%)]

乳腺癌分型	TA	TP	TCH	共计
ER(+)/HER-2(-)	9(29.0)	1(3.2)	0(0.0)	10(32.2)
ER(-)/HER-2(-)	2(6.5)	6(19.4)	0(0.0)	8(25.8)
ER(+)/HER-2(+)	3(9.7)	2(6.5)	1(3.2)	6(19.4)
ER(-)/HER-2(+)	3(9.7)	0(0.0)	4(12.9)	7(22.6)
共计	17(54.9)	9(29.0)	5(16.1)	31(100.0)

表3 31 例乳腺癌患者的术前化疗方案 [例(%)]

乳腺癌分型	TA	TP	TCH	共计
ER(+)/HER-2(-)	9(29.0)	1(3.2)	0(0.0)	10(32.2)
ER(-)/HER-2(-)	2(6.5)	6(19.4)	0(0.0)	8(25.8)
ER(+)/HER-2(+)	3(9.7)	2(6.5)	1(3.2)	6(19.4)
ER(-)/HER-2(+)	3(9.7)	0(0.0)	4(12.9)	7(22.6)
共计	17(54.9)	9(29.0)	5(16.1)	31(100.0)

图1 新辅助化疗前后MRI 评价 a: 化疗前;b: 化疗后

表4 MRI 疗效评价与组织病理学疗效评价的关系例

MRI疗效评价	组织病理学疗效评价					共计
MRI疗效评价	G1	G2	G3	G4	G5	共计
PD	0	1	0	0	0	1
SD	0	1	1	0	0	2
PR	1	2	7	5	8	23
CR	0	0	0	0	5	5
共计	1	4	8	5	13	31

表4 MRI 疗效评价与组织病理学疗效评价的关系例

MRI疗效评价	组织病理学疗效评价					共计
MRI疗效评价	G1	G2	G3	G4	G5	共计
PD	0	1	0	0	0	1
SD	0	1	1	0	0	2
PR	1	2	7	5	8	23
CR	0	0	0	0	5	5
共计	1	4	8	5	13	31

[1]	Eisenhauer EA,Therasse P, Bogaerts J , et al. New response evaluation criteria in solid tumours:Revised RECIST guideline(version 1.1)[J]. Eur J cancer,2009, 45(2):228-247.
[2]	Ogston KN, Miller ID, Payne S, et al. A new histological grading system to assess response of breast cancers to primary chemotherapy: prognostic significance and survival[J]. Breast, 2003, 12(6): 320-327.
[3]	Hammond MEH, Hayes DF, Dowsett M, et al. American Society of Clinical Oncology/College of American Pathologists Guideline Recommendations for Immunohistochemical Testing of Estrogen and Progesterone Receptors in Breast Cancer[J]. J Clin Oncol, 2010,28(16):2784-2795.
[4]	Rastogi P, Anderson SJ, Bear HD, et al.Preoperative chemotheraphy:updates of National Surgical adjuvant breast and bowel project protocols B-18 and B-27[J].J Clin Oncol,2008,26(5):778-785.
[5]	Bollet MA, Thibault F,Bouillon K,et al. Role of dynamic magnetic resonance imaging in the evaluation of tumor response to preoperative concurrent radiochemotherapy for large breast cancers:a prospective phase II study[J]. Int J Radiat Oncol Biol Phys,2007,69(1):13-18.
[6]	Liu YH, Ye JM, Xu L, et al. Effectiveness of dynamic contrast-enhanced magnetic resonance imaging in evaluation clinical responses to neoadjuvant chemotherapy in breast cancer[J]. Chin Med J,2011,124(2):194-198.
[7]	刘志洋, 张瑾. 新辅助化疗TE 与CEF 方案治疗乳腺癌的临床效果比较[J/CD]. 中华乳腺病杂志:电子版, 2008,2(1): 30-39.
[8]	Precht LM, Lowe KA, Atwood M, et al. Neoadjuvant chemotherapy of breast cancer: tumor markers as predictors of pathologic response, recurrence, and survival[J]. Breast J,2010,16(4):362-368.
[9]	Buzdar AU, Ibrahim NK, Francis D, et al. Significantly higher pathologic complete remission rate after neoadjuvant therapy with trastuzumab,paclitaxel, and epirubicin chemotherapy: results of a randomized trial in human epidermal growth factor receptor 2-positive operable breast cancer [J]. J Clin Oncol, 2005,23 (16): 3676-3685.
[10]	徐玲, 刘荫华, 叶京明,等.乳腺癌组织Ki67 表达与蒽环类联合紫杉类新辅助化疗效果的相关性[J]. 中华外科杂志,2010,48(6):450-453.
[11]	Sirohi B, Arnedos M, Popat S, et al. Platinum based chemotherapy in triple negative breast cancer[J]. Ann Oncol,2008,19(11):1-6.

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Dynamic enhanced MRI evaluation on therapeutic effect of preoperative chemotherapy for breast cancer patients and analysis of related factors: a report of 31 cases

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Dynamic enhanced MRI evaluation on therapeutic effect of preoperative chemotherapy for breast cancer patients and analysis of related factors: a report of 31 cases