应用1HMR波谱在新辅助化疗早期评估乳腺癌化疗效果的研究

目的 应用1HMRS评价化疗早期复合胆碱(tCho)浓度变化在早期评估乳腺癌新辅助化疗效果的价值.方法 搜集已确诊为乳腺癌(肿瘤T分期在T1c以上者)并进行新辅助化疗的患者20例.所有患者化疗前均进行乳腺病变穿刺活检,在化疗结束后均进行手术治疗.将手术病理切片与化疗前穿刺病理片比较,将患者分为化疗有效组和无效组.所有患者均在化疗前1周内及化疗第1疗程结束后3周内(化疗第二疗程开始前)各进行1次乳腺MRS检查.采用外参照定量法计算化疗前、后tCho浓度,并采用配对样本均数t检验比较2组统计学意义.采用秩和检验比较2组病灶大小的统计学意义.以病理作为金标准,用ROC曲线分析根据tCho浓度变化判断化疗有效的价值.结果 20例中化疗有效为16例,无效为4例.化疗有效组化疗前、后胆碱浓度分别为(4.24±3.09)、(1.13±1.14)mmol/L,两者差异有统计学意义(t=5.040,P<0.01),而无效组[(3.72±2.69)、(3.06±2.21)mmol/L]差异无统计学意义(t=1.785,P>0.05).2组间病灶大小变化值(中位数均为0 cm)差异无统计学意义(U=23.00,W=33.00,P=0.437).以病理作为金标准根据化疗前、后的tCho浓度变化评估化疗有效性的ROC曲线下而积为0.984.结论 MRS能在肿瘤大小发生改变之前即反映出肿瘤代谢的变化,从而能在新辅助化疗早期评估其疗效.

Neoadjuvant chemotherapy of breast cancer: early assessment of therapeutic response with in-vivo 1HMR spectroscopy

Objective To investigate the values of tCho concentration in early assessment therapeutic response of tumor to neoadjuvant chemotherapy with 1HMR spectroscopy. Methods Twenty patients with breast cancer were recruited. All patients underwent biopsy before neoadjuvant chemotherapy and surgery after chemotherapy. The pathologic results before and after neoadjuvant chemotherapy were compared. The patients were divided into effective response group (R) and ineffective response group (IR). MRS acquisitions were performed within 1 week before chemotherapy and within 3 week after the first cycle of chemotherapy, respectively. The tCho concentration was calculated quantitatively using external standard method. The tCho concentrations before and after chemotherapy and the tumor sizes between R group and IR group were compared using t test and nonparametrie test. The values of tCho concentration in early assessment of the effectiveness of chemotherapy were analyzed by ROC. Results Of 20 cases, 16 were included in R group and 4 in IR group. In R group, significant differences of tCho concentration (t=5. 040, P < 0. 01 ) existed between before and after chemotherapy [ (4. 24 ± 3.09 ), ( 1.13 ± 1.14 ) mmol/L ], while not in I R group [ ( 3.72 ± 2. 69), ( 3.06 ± 2. 21 ) mmol/L, t = 1. 785, P > 0. 05 ]. The median sizes of tumor between R and IR group had no significant differences (0. 00,0. 00 cm, U = 23.00, W = 33.00, P = 0. 437). The area under ROC curve of tCho concentration was 0. 984. Conclusion With in vivo 1HMRS, the tChn concentration in breast cancer can serve as an indicator for predicting response to neoadjuvant chemotherapy with relatively high sensitivity and specificity.