Accuracy of unidimensional and volumetric ultrasound measurements in predicting good pathological response to neoadjuvant chemotherapy in breast cancer patients
Accuracy of unidimensional and volumetric ultrasound measurements in predicting good pathological response to neoadjuvant chemotherapy in breast cancer patients
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DOI：
10.1007/s10549-011-1454-x
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发表时间：
2011-06-01
影响因子：
3.8
通讯作者：
Sinnatamby, R.
中科院分区：
文献类型：
--
作者：
Gounaris, I.;Provenzano, E.;Sinnatamby, R.
病理完全缓解（pCR）是乳腺癌患者接受新辅助化疗（NAC）后长期生存的重要预测指标。目前，治疗期间传统放射学评估预测pCR的准确性较差。在化疗前、化疗4个周期后（治疗中期）和化疗8个周期结束时（治疗结束），可从Neo-tAnGo（英国国家癌症研究网络（NCRN）新辅助化疗乳腺癌试验）中招募的55例患者亚组中获得一维和3D体积超声测量结果。检查了最长直径（LD）和体积的比例变化以及绝对残留尺寸阈值预测pCR或pCR+微小残留病变（pCR/MRD）的能力。计算敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）以及似然比（LR）。还构建了受试者-操作者特征（ROC）曲线和logistic回归模型。在治疗中期，无论是完全放射学反应，也不是LD或体积的比例变化被发现预测最终的pCR。然而，在治疗中期，小的残留肿瘤体积（千分之一货币符号1 cm（3）与> 1 cm（3））与pCR/MRD相关（P = 0.014）。敏感性、特异性、PPV、NPV、LR+和LR-值分别为61%、77%、61%、77%、2.62和0.51。ROC曲线下面积为0.689（P = 0.03）。Logistic回归分析显示治疗中期的千分之一货币符号体积1cm（3）有显著性差异（OR：0.194，P = 0.011）。在治疗结束时，未发现超声测量值可预测pCR或pCR/MRD。总之，发现肿瘤大小的比例变化（RECIST标准的基础）不能预测良好的病理学反应，尽管发现治疗中期的残留体积a千分之一货币符号1 cm（3）可预测pCR/MRD。然而，检查了多个体积和LD阈值，并提供了未校正的P值，增加了I型错误的可能性。需要在独立数据集中进行复制。
Pathological complete response (pCR) is an important predictor of long-term survival in patients with breast cancer receiving neoadjuvant chemotherapy (NAC). At present, the accuracy of traditional radiological assessments during treatment in predicting pCR is poor. Unidimensional and 3D volumetric ultrasound measurements prior to, after 4 cycles (mid-treatment), and at the end of 8 cycles (end-treatment) of chemotherapy were available from a subset of 55 patients enrolled in Neo-tAnGo, a National Cancer Research Network (NCRN) UK neoadjuvant chemotherapy breast cancer trial. Proportional changes in longest diameter (LD) and volume as well as absolute residual size thresholds were examined for their ability to predict pCR or pCR plus minimal residual disease (pCR/MRD). Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) and likelihood ratios (LRs) were calculated. Receiver-operator characteristic (ROC) curves and logistic regression models were also constructed. At mid-treatment, neither complete radiological response, nor proportional LD or volume changes were found predictive of final pCR. A small residual tumour volume (a parts per thousand currency sign1 cm(3) vs. > 1 cm(3)) at mid-treatment, however, was associated with pCR/MRD (P = 0.014). Sensitivity, specificity, PPV, NPV, LR+ and LR- values were 61%, 77%, 61%, 77%, 2.62 and 0.51, respectively. The area under the ROC curve was 0.689 (P = 0.03). Volume a parts per thousand currency sign1 cm(3) at mid-treatment was found significant in a logistic regression (OR: 0.194, P = 0.011). At end-treatment, no ultrasound measurements were found predictive of pCR or pCR/MRD. In conclusion, proportional tumour size changes (the basis of the RECIST criteria) were not found predictive of good pathological response, although residual volume a parts per thousand currency sign1 cm(3) at mid-treatment was found to be predictive of pCR/MRD. However, multiple volume and LD thresholds were examined and uncorrected P values presented, increasing the possibility of type I errors. Replication in an independent dataset is required.