Magnetic resonance imaging as a predictor of pathologic response in patients treated with neoadjuvant systemic treatment for operable breast cancer Translational Breast Cancer Research Consortium Trial 017
Magnetic resonance imaging as a predictor of pathologic response in patients treated with neoadjuvant systemic treatment for operable breast cancer Translational Breast Cancer Research Consortium Trial 017
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DOI：
10.1002/cncr.27995
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发表时间：
2013-05-15
期刊：
影响因子：
6.2
通讯作者：
Hwang, E. Shelley
中科院分区：
文献类型：
--
作者：
De los Santos, Jennifer F.;Cantor, Alan;Hwang, E. Shelley
背景技术背景：新辅助化疗（NCT）在浸润性乳腺癌患者的某些亚组中观察到病理完全缓解（pCR）率增加，这促使人们关注是否可以在术前识别达到pCR的患者，并可能避免手术的发病率。这项多中心、回顾性研究的目的是评估术前磁共振成像（MRI）预测乳腺pCR的准确性。方法：从2002年至2011年期间在8家机构接受治疗的746名女性中回顾性收集了基线和NCT完成后的MRI研究以及有关病理反应的数据。肿瘤通过免疫组织化学表型根据受体表达分为4类：激素（雌激素和孕酮）受体（HR）阳性/人表皮生长因子受体2（HER 2）阴性（n = 327）、HR阳性/HER 2阳性（n = 148）、HR阴性/HER 2阳性（n = 101）和三阴性（HR阴性/HER 2阴性; n = 155）。249例HER 2阳性肿瘤患者中有194例（78%）接受了曲妥珠单抗治疗。对与放射学完全缓解（rCR）和pCR相关的因素进行单变量和多变量分析。测试结果：对于总组，rCR和pCR率分别为182/746例患者（24%）和179/746例患者（24%），三阴性亚型（57/155例患者; 37%）和HER 2阳性亚型（38/101例患者; 38%）的pCR率最高。MRI预测pCR的总体准确性为74%。变量敏感性、阴性预测值、阳性预测值和准确性在肿瘤亚型之间存在显著差异，在三阴性（60%）和HER 2阳性（62%）亚型中观察到最大的阴性预测值。结论：MRI预测接受NCT的浸润性乳腺癌患者pCR的总体准确性为74%。MRI的性能在亚型之间存在差异，可能受到组间pCR率差异的影响。未来的研究将确定MRI联合直接空芯针活检是否能提高MRI对病理反应的预测价值。癌症2013年。(c)2013年美国癌症协会
BACKGROUND: Increased pathologic complete response (pCR) rates observed with neoadjuvant chemotherapy (NCT) for some subsets of patients with invasive breast cancer have prompted interest in whether patients who achieved a pCR can be identified preoperatively and potentially spared the morbidity of surgery. The objective of this multicenter, retrospective study was to estimate the accuracy of preoperative magnetic resonance imaging (MRI) in predicting a pCR in the breast. METHODS: MRI studies at baseline and after the completion of NCT plus data regarding pathologic response were collected retrospectively from 746 women who received treatment at 8 institutions between 2002 and 2011. Tumors were characterized by immunohistochemical phenotype into 4 categories based on receptor expression: hormone (estrogen and progesterone) receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-negative (n = 327), HR-positive/HER2-positive, (n = 148), HR-negative/HER2-positive, (n = 101), and triple-negative (HR-negative/HER2 negative; n = 155). In all, 194 of 249 patients (78%) with HER2-positive tumors received trastuzumab. Univariate and multivariate analyses of factors associated with radiographic complete response (rCR) and pCR were performed. RESULT: For the total group, the rCR and pCR rates were 182 of 746 patients (24%) and 179 of 746 patients (24%), respectively, and the highest pCR rate was observed for the triple-negative subtype (57 of 155 patients; 37%) and the HER2-positive subtype (38 of 101 patients; 38%). The overall accuracy of MRI for predicting pCR was 74%. The variables sensitivity, negative predictive value, positive predictive value, and accuracy differed significantly among tumor subtypes, and the greatest negative predictive value was observed in the triple-negative (60%) and HER2-positive (62%) subtypes. CONCLUSIONS: The overall accuracy of MRI for predicting pCR in invasive breast cancer patients who were receiving NCT was 74%. The performance of MRI differed between subtypes, possibly influenced by differences in pCR rates between groups. Future studies will determine whether MRI in combination with directed core biopsy improves the predictive value of MRI for pathologic response. Cancer 2013. (c) 2013 American Cancer Society.