乳腺癌新辅助化疗后微钙化减少对肿瘤病理完全反应的预测

刘文佳; 刘雨潇; 杨正军; 李君辉; 曹旭晨

doi:10.3969/j.issn.1000-8179.2020.03.300

乳腺癌新辅助化疗后微钙化减少对肿瘤病理完全反应的预测

doi: 10.3969/j.issn.1000-8179.2020.03.300

天津医科大学肿瘤医院乳腺一科, 国家肿瘤临床医学研究中心, 天津市肿瘤防治重点实验室, 天津市恶性肿瘤临床医学研究中心, 乳腺癌防治教育部重点实验室(天津市 300060)

详细信息

作者简介:
刘文佳专业方向为乳腺肿瘤外科临床治疗。E-mail:2585467573@qq.com

通讯作者:
曹旭晨, caoxuchen@tmu.edu.cn

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出版历程
- 收稿日期: 2019-11-25
- 刊出日期: 2020-02-15

Prediction of complete pathological response to neoadjuvant chemotherapy in patients with breast cancer with reduced microcalcification

First Department of Breast Surgery, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer; Tianjin 300060, China

More Information

Corresponding author: Xuchen Cao, caoxuchen@tmu.edu.cn

摘要

摘要: 目的探讨乳腺癌患者新辅助化疗（neoadjuvant chemotherapy，NAC）后影响微钙化（mcrocalcification，MC）改变的因素及MC减少与肿瘤病理完全反应（pathological complete response，pCR）的相关性。方法收集2015年1月至2018年12月天津医科大学肿瘤医院215例乳腺癌患者的临床资料，分为范围改变组及数量改变组，评估影响MC改变的因素。根据MC是否减少进行分组，分为MC范围缩小组及MC数量减少组，分析不同分子分型中MC减少与pCR的相关性。采用受试者工作特征曲线（receiver operat-ing characteristic curve，ROC）评价乳腺X线摄影（mammography，MG）检查中MC减少对pCR敏感性、特异性的预测。结果 MC呈弥散分布，范围>2 cm，数量>20个患者更易发生MC减少。MC范围缩小组较非缩小组易发生pCR。MC数量减少组与非减少组比较差异无统计学意义，分子分型不是MC范围缩小及数量减少与pCR的影响因素。MC范围缩小组预测pCR的敏感度为77.78%、特异度为57.45%（P=0.000 1）。结论乳腺癌患者NAC后MC改变因素为MC范围、数量及分布，MC范围缩小患者的pCR率高，但MC范围缩小对预测pCR准确性较低，暂不推荐MG检查评估NAC后是否达到pCR。
- 乳腺癌 /
- 新辅助化疗 /
- 微钙化 /
- 病理完全反应
Abstract: Objective To investigate causes and factors affecting microcalcification (MC) changes after neoadjuvant chemotherapy (NAC) in patients with breast cancer and to assess the correlation between MC reduction and complete remission rate [pathological complete response (pCR)] of tumors. Methods Clinical data of 215 patients with breast cancer who visited Tianjin Medical University Cancer Hospital from January 1, 2015 to December 31, 2018 were collected. The patients were grouped according to MC range and number of changes, and factors that affected MC changes were evaluated. According to whether MC decreased or not, the patient group was divided into the MC range and MC number reduction groups, and the correlation between the decrease in MC and pCR, assessed using different molecular typing methods, was analyzed. The sensitivity and specificity of the receiver operating characteristic curve analysis (ROC) were used to evaluate the accuracy of MC reduction in predicting pCR. Results The patients with a distribution of diffuse, initial MC range of >2 cm and MC quantity of >20 were more likely to have an MC reduction. The pCR rate was higher in the group with reduced and non-reduced MC. No significant difference was found between the group with decreased MC and the control group. The decreases in MC according to the different molecular typing methods were independent of factors affecting pCR. Reduction in MC range predicts pCR with a sensitivity of 77.78 and specificity of 57.45 (P=0.0001). Conclusions The change factors of MC in patients with breast cancer after neoadjuvant chemotherapy were the range, number, and distribution of calcification. The pCR rate of the patients with reduced MC was high, but the accuracy of pCR prediction based on reduced MG was low. Thus, mammography was not recommended for evaluating pCR after neoadjuvant chemotherapy.
- breast cancer /
- neoadjuvant chemotherapy /
- microcalcification /
- complete pathological response

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图 1 MG检查MC范围改变示意图

A：NAC前；B：NAC后

下载: 全尺寸图片幻灯片

图 2 MG检查MC数量改变示意图

A：NAC前；B：NAC后

下载: 全尺寸图片幻灯片

表 1 215例乳腺癌患者行NAC后MC的病理特征和MC变化模式

表 2 MC减少与pCR的相关性分析

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