Locally Advanced Breast Cancer: MR Imaging for Prediction of Response to Neoadjuvant Chemotherapy-Results from ACRIN 6657/I-SPY TRIAL
Locally Advanced Breast Cancer: MR Imaging for Prediction of Response to Neoadjuvant Chemotherapy-Results from ACRIN 6657/I-SPY TRIAL
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DOI：
10.1148/radiol.12110748
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发表时间：
2012-06-01
期刊：
影响因子：
19.7
通讯作者：
Schnall, Mitchell D.
中科院分区：
文献类型：
--
作者：
Hylton, Nola M.;Blume, Jeffrey D.;Schnall, Mitchell D.
目的：比较磁共振（MR）成像结果和临床评估对II期和III期乳腺癌患者新辅助化疗（NACT）病理反应的预测。材料和方法：符合hipaa的协议和知情同意过程由美国放射学会机构审查委员会和当地机构审查委员会批准。在2002年5月至2006年3月期间，患有3厘米或更大浸润性乳腺癌的妇女接受了以蒽环类药物为基础的NACT治疗，有或没有紫杉烷。在NACT前（第一次检查）、蒽环类药物治疗一个周期后（第二次检查）、蒽环类药物治疗方案与紫杉烷治疗方案之间（第三次检查）、所有化疗后和手术前（第四次检查）进行MR成像。磁共振成像评估包括测量肿瘤最长直径、体积和峰值信号增强比。在每个时间点记录临床大小。比较临床和MR成像预测变量的变化，以预测病理完全缓解（pCR）和残余癌症负担（RCB）的能力。使用单变量和多变量随机效应logistic回归模型来表征肿瘤反应测量预测病理结局的能力，并使用受试者工作特征曲线下面积（AUC）作为汇总统计量。结果：分析了216名女性（年龄范围，26-68岁）有两个或两个以上影像学时间点的数据。对于pCR和RCB的预测，MR成像大小测量在所有时间点都优于临床检查，肿瘤体积变化在第二次MR成像检查时显示出最大的相对优势。MR成像体积和临床大小预测因子在治疗早期、中期和治疗后时间点的AUC差异分别为：预测pCR的0.14、0.09和0.02，预测RCB的0.09、0.07和0.05。在多变量分析中，预测第二次成像检查pCR的AUC从单独体积的0.70增加到使用所有四个预测变量时的0.73。通过调整年龄和种族，获得了额外的预测价值。结论：MR成像结果比临床评估更能预测NACT的病理反应，在治疗早期使用体积测量肿瘤反应观察到最大的优势。(c) RSNA， 2012年
Purpose: To compare magnetic resonance (MR) imaging findings and clinical assessment for prediction of pathologic response to neoadjuvant chemotherapy (NACT) in patients with stage II or III breast cancer.Materials and Methods: The HIPAA-compliant protocol and the informed consent process were approved by the American College of Radiology Institutional Review Board and local-site institutional review boards. Women with invasive breast cancer of 3 cm or greater undergoing NACT with an anthracycline-based regimen, with or without a taxane, were enrolled between May 2002 and March 2006. MR imaging was performed before NACT (first examination), after one cycle of anthracyline-based treatment (second examination), between the anthracycline-based regimen and taxane ( third examination), and after all chemotherapy and prior to surgery (fourth examination). MR imaging assessment included measurements of tumor longest diameter and volume and peak signal enhancement ratio. Clinical size was also recorded at each time point. Change in clinical and MR imaging predictor variables were compared for the ability to predict pathologic complete response (pCR) and residual cancer burden (RCB). Univariate and multivariate random-effects logistic regression models were used to characterize the ability of tumor response measurements to predict pathologic outcome, with area under the receiver operating characteristic curve (AUC) used as a summary statistic.Results: Data in 216 women (age range, 26-68 years) with two or more imaging time points were analyzed. For prediction of both pCR and RCB, MR imaging size measurements were superior to clinical examination at all time points, with tumor volume change showing the greatest relative benefit at the second MR imaging examination. AUC differences between MR imaging volume and clinical size predictors at the early, mid-, and posttreatment time points, respectively, were 0.14, 0.09, and 0.02 for prediction of pCR and 0.09, 0.07, and 0.05 for prediction of RCB. In multivariate analysis, the AUC for predicting pCR at the second imaging examination increased from 0.70 for volume alone to 0.73 when all four predictor variables were used. Additional predictive value was gained with adjustments for age and race.Conclusion: MR imaging findings are a stronger predictor of pathologic response to NACT than clinical assessment, with the greatest advantage observed with the use of volumetric measurement of tumor response early in treatment. (c) RSNA, 2012