术前磁共振T_2WI瘤周水肿征象对浸润性乳腺癌早期复发的诊断价值
|
摘要
目的探讨磁共振T_2WI瘤周水肿征象对浸润性乳腺癌早期复发的诊断价值。方法回顾性分析我院116例浸润性乳腺癌患者的临床病历资料,根据T_2WI瘤周水肿征象分为阳性组与阴性组。比较两组浸润性乳腺癌的临床病理特征以及术后早期复发与T_2WI瘤周水肿的关系,Kaplan-Miere法绘制患者无病生存曲线,采用Cox风险比例回归模型分析影响乳腺癌术后复发的因素。结果 116例乳腺癌患者中,T_2WI瘤周水肿阳性39例、阴性77例;与T_2WI瘤周水肿阴性组比较,阳性组T分期、N分期更高,且Ki-67高表达率以及淋巴管浸润的比例更高,ER/PR、HER-2阳性率更低(P <0. 05)。T_2WI瘤周水肿征阳性组和阴性组的3年无病生存率分别为56. 4%、89. 6%,差异有统计学意义(P <0. 05)。单因素分析显示,T分期、N分期、淋巴管浸润、T_2WI瘤周水肿征与乳腺癌术后早期复发有关(P <0. 05)。多因素分析显示,T_2WI瘤周水肿征阳性(HR=3. 226,95%CI:1. 033～10. 078,P=0. 044)、N2～N3(HR=3. 477,95%CI:1. 122～10. 775,P=0. 031)是浸润性乳腺癌早期复发的独立危险因素。结论术前磁共振T_2WI瘤周水肿征象对浸润性乳腺癌早期复发具有较大的预测价值。
Objective To investigate the diagnostic value of magnetic resonance T_2 WI peritumoral edema signs in early recurrence of invasive breast cancer. Methods The clinical data of 116 patients with invasive breast cancer in our hospital were retrospectively analyzed. According to the signs of peritumoral edema on T_2 WI,the patients were divided into positive group and negative group. The clinicopathological features of invasive breast cancer and the relationship between the postoperative early recurrence and preoperative peritumoral edema on T_2 WI were compared. Kaplan-Miere method was used to draw the survival curve of disease free survival,and Cox risk proportional model was used to analyze the factors affecting recurrence of breast cancer after operation. Results Peritumoral edema on T_2 WI was positive in 39 cases and negative in 77 cases. Compared with the negative group of peritumoral edema on T_2 WI,the positive group had higher T stage and N stage,higher Ki-67 expression rate and lymphatic infiltration rate,lower ER/PR and HER-2 positive rate( P < 0. 05). The three-year disease-free survival rates of the positive and negative groups with T_2 WI peritumoral edema sign were 56. 4% and 89. 6%,with significant difference( P < 0. 05). Univariate analysis showed that T stage,N stage,lymphatic vessel infiltration and peritumoral edema sign of T_2 WI were associated with early recurrence of breast cancer after operation( P < 0. 05). Multivariate analysis showed that positive peritumoral edema sign of T_2 WI( HR = 3. 226,95% CI: 1. 033-10. 078,P =0. 044) and N2-N3( HR = 3. 477,95% CI: 1. 122-10. 775,P = 0. 031) were independent risk factors for early recurrence of invasive breast cancer. Conclusion Preoperative MR T_2 WI signs of peritumoral edema have great predictive value for early recurrence of invasive breast cancer.
Objective To investigate the diagnostic value of magnetic resonance T_2 WI peritumoral edema signs in early recurrence of invasive breast cancer. Methods The clinical data of 116 patients with invasive breast cancer in our hospital were retrospectively analyzed. According to the signs of peritumoral edema on T_2 WI,the patients were divided into positive group and negative group. The clinicopathological features of invasive breast cancer and the relationship between the postoperative early recurrence and preoperative peritumoral edema on T_2 WI were compared. Kaplan-Miere method was used to draw the survival curve of disease free survival,and Cox risk proportional model was used to analyze the factors affecting recurrence of breast cancer after operation. Results Peritumoral edema on T_2 WI was positive in 39 cases and negative in 77 cases. Compared with the negative group of peritumoral edema on T_2 WI,the positive group had higher T stage and N stage,higher Ki-67 expression rate and lymphatic infiltration rate,lower ER/PR and HER-2 positive rate( P < 0. 05). The three-year disease-free survival rates of the positive and negative groups with T_2 WI peritumoral edema sign were 56. 4% and 89. 6%,with significant difference( P < 0. 05). Univariate analysis showed that T stage,N stage,lymphatic vessel infiltration and peritumoral edema sign of T_2 WI were associated with early recurrence of breast cancer after operation( P < 0. 05). Multivariate analysis showed that positive peritumoral edema sign of T_2 WI( HR = 3. 226,95% CI: 1. 033-10. 078,P =0. 044) and N2-N3( HR = 3. 477,95% CI: 1. 122-10. 775,P = 0. 031) were independent risk factors for early recurrence of invasive breast cancer. Conclusion Preoperative MR T_2 WI signs of peritumoral edema have great predictive value for early recurrence of invasive breast cancer.
引文
[1] Ciriello G,Gatza ML,Beck AH,et al. Comprehensive molecu-lar portraits of invasive lobular breast c Cancer[J]. Cell,2015,163(2):506-519.
[2] Liedtke C,Rody A,Gluz O,et al. The prognostic impact of agein different molecular subtypes of breast cancer[J]. Breast Canc-er Res Treat,2015,152(3):667-773.
[3] Lee Y,Kang E,Lee AS,et al. Outcomes and recurrence pat-terns according to breast cancer subtypes in Korean women[J].Breast Cancer Res Treat,2015,151(1):183-190.
[4] Hashmi AA,Mahboob R,Khan SM,et al. Clinical and prognos-tic profile of Her2neu positive(non-luminal)intrinsic breastcancer subtype:comparison with Her2neu positive luminal breastcancers[J]. BMC Res Notes,2018,11(1):574.
[5] Giardino A,Gupta S,Olson E,et al. Role of imaging in the eraof precision medicine[J]. Acad Radiol,2017,24(5):639-649.
[6] Saunders C,Taylor D. Expanding the indications for MRI in thediagnosis and treatment of breast cancer:what is best practice?[J]. J Med Radiat Sci,2015,62(1):47-53.
[7] Uematsu T. Focal breast edema associated with malignancy onT2-weighted images of breast MRI:peritumoral edema,prepec-toral edema, and subcutaneous edema[J]. Breast Cancer,2015,22(1):66-70.
[8] Yin J,Yang J,Jiang Z. Discrimination between malignant andbenign mass-like lesions from breast dynamic contrast enhancedMRI:semi-automatic vs. manual analysis of the signal time-in-tensity curves[J]. J Cancer,2018,9(5):834-840.
[9] Hammond ME,Hicks DG. American society of clinical oncolo-gy/college of american pathologists human epidermal growth fac-tor receptor 2 testing clinical practice guideline upcoming modifi-cations:Proof that clinical practice guidelines are living docu-ments[J]. Arch Pathol Lab Med,2015,139(8):970-971.
[10]王宝娜,王翔,王靖,等. Ki67在乳腺癌中的表达及临床意义[J].中华肿瘤杂志,2014,36(4):273-275.
[11]姚家炳,贾琳娇,司丕蕾,等.乳腺癌淋巴管侵犯与淋巴结转移率的相关性研究[J].中华普通外科学文献(电子版),2018,1:28-31.
[12] Choi EJ,Choi HM,Choi SA,et al. Dynamic contrast-enhancedbreast magnetic resonance imaging for the prediction of early andlate recurrences in breast cancer[J/OL]. Medicine, 2016[2018-04-06]. https://www. ncbi. nlm. nih. gov/pmc/articles-/PMC5134812/.
[13]梁晓东,黄文斌,王劲松.食管鳞状细胞癌间质细胞中podo-planin的表达及临床意义[J].临床与实验病理学杂志,2015,31(2):128-131.
[14]王亮,何裕隆,张常华,等. CXCL1促进胃癌淋巴道转移的实验研究[J].消化肿瘤杂志(电子版),2015,7(2):94-98.
[15] Wu CX,Lin GS,Lin ZX,et al. Peritumoral edema on magneticresonance imaging predicts a poor clinical outcome in malignantglioma[J]. Oncol Lett,2015,10(5):2769-2776.
[16] Gutman DA,Cooper LA,Hwang SN,et al. MR imaging predic-tors of molecular profile and survival:multi-institutional study ofthe TCGA glioblastoma data set[J]. Radiology,2013,267(2):560-569.
[17] Bae MS,Shin SU,Ryu HS,et al. Pretreatment MR iaging fa-tures of tiple-ngative beast cncer:Association with rsponse to no-adjuvant cemotherapy and rcurrence-fee srvival[J]. Radiology,2016,281(2):392-440.
[18] Baltzer PA,Yang F,Dietzel M,et al. Sensitivity and specificityof unilateral edema on T2w-TSE sequences in MR-Mammographyconsidering 974 histologically verified lesions[J]. Breast J,2010,16(3):233-239.
[19] Koyama H,Kobayashi N,Harada M,et al. Significance oftumor-associated stroma in promotion of intratumoral lymphangio-genesis:pivotal role of a hyaluronan-rich tumor microenvironment[J]. Am J Pathol,2008,172(1):179-193.
[20] Auvinen P,Tammi R,Parkkinen J,et al. Hyaluronan in peritu-moral stroma and malignant cells associates with breast cancerspreading and predicts survival.[J]. Am J Pathol,2000,156(2):529-536.
[2] Liedtke C,Rody A,Gluz O,et al. The prognostic impact of agein different molecular subtypes of breast cancer[J]. Breast Canc-er Res Treat,2015,152(3):667-773.
[3] Lee Y,Kang E,Lee AS,et al. Outcomes and recurrence pat-terns according to breast cancer subtypes in Korean women[J].Breast Cancer Res Treat,2015,151(1):183-190.
[4] Hashmi AA,Mahboob R,Khan SM,et al. Clinical and prognos-tic profile of Her2neu positive(non-luminal)intrinsic breastcancer subtype:comparison with Her2neu positive luminal breastcancers[J]. BMC Res Notes,2018,11(1):574.
[5] Giardino A,Gupta S,Olson E,et al. Role of imaging in the eraof precision medicine[J]. Acad Radiol,2017,24(5):639-649.
[6] Saunders C,Taylor D. Expanding the indications for MRI in thediagnosis and treatment of breast cancer:what is best practice?[J]. J Med Radiat Sci,2015,62(1):47-53.
[7] Uematsu T. Focal breast edema associated with malignancy onT2-weighted images of breast MRI:peritumoral edema,prepec-toral edema, and subcutaneous edema[J]. Breast Cancer,2015,22(1):66-70.
[8] Yin J,Yang J,Jiang Z. Discrimination between malignant andbenign mass-like lesions from breast dynamic contrast enhancedMRI:semi-automatic vs. manual analysis of the signal time-in-tensity curves[J]. J Cancer,2018,9(5):834-840.
[9] Hammond ME,Hicks DG. American society of clinical oncolo-gy/college of american pathologists human epidermal growth fac-tor receptor 2 testing clinical practice guideline upcoming modifi-cations:Proof that clinical practice guidelines are living docu-ments[J]. Arch Pathol Lab Med,2015,139(8):970-971.
[10]王宝娜,王翔,王靖,等. Ki67在乳腺癌中的表达及临床意义[J].中华肿瘤杂志,2014,36(4):273-275.
[11]姚家炳,贾琳娇,司丕蕾,等.乳腺癌淋巴管侵犯与淋巴结转移率的相关性研究[J].中华普通外科学文献(电子版),2018,1:28-31.
[12] Choi EJ,Choi HM,Choi SA,et al. Dynamic contrast-enhancedbreast magnetic resonance imaging for the prediction of early andlate recurrences in breast cancer[J/OL]. Medicine, 2016[2018-04-06]. https://www. ncbi. nlm. nih. gov/pmc/articles-/PMC5134812/.
[13]梁晓东,黄文斌,王劲松.食管鳞状细胞癌间质细胞中podo-planin的表达及临床意义[J].临床与实验病理学杂志,2015,31(2):128-131.
[14]王亮,何裕隆,张常华,等. CXCL1促进胃癌淋巴道转移的实验研究[J].消化肿瘤杂志(电子版),2015,7(2):94-98.
[15] Wu CX,Lin GS,Lin ZX,et al. Peritumoral edema on magneticresonance imaging predicts a poor clinical outcome in malignantglioma[J]. Oncol Lett,2015,10(5):2769-2776.
[16] Gutman DA,Cooper LA,Hwang SN,et al. MR imaging predic-tors of molecular profile and survival:multi-institutional study ofthe TCGA glioblastoma data set[J]. Radiology,2013,267(2):560-569.
[17] Bae MS,Shin SU,Ryu HS,et al. Pretreatment MR iaging fa-tures of tiple-ngative beast cncer:Association with rsponse to no-adjuvant cemotherapy and rcurrence-fee srvival[J]. Radiology,2016,281(2):392-440.
[18] Baltzer PA,Yang F,Dietzel M,et al. Sensitivity and specificityof unilateral edema on T2w-TSE sequences in MR-Mammographyconsidering 974 histologically verified lesions[J]. Breast J,2010,16(3):233-239.
[19] Koyama H,Kobayashi N,Harada M,et al. Significance oftumor-associated stroma in promotion of intratumoral lymphangio-genesis:pivotal role of a hyaluronan-rich tumor microenvironment[J]. Am J Pathol,2008,172(1):179-193.
[20] Auvinen P,Tammi R,Parkkinen J,et al. Hyaluronan in peritu-moral stroma and malignant cells associates with breast cancerspreading and predicts survival.[J]. Am J Pathol,2000,156(2):529-536.