乳腺癌新辅助化疗初期超声评效预测病理评价的可行性

目的 观察新辅助化疗2周期后病灶径线变化与4周期后病理评效结果间的相关性,探讨应用超声评效方法预测乳腺癌新辅助化疗疗效的可行性.方法 回顾性观察了138例完成4周期CTFci4w环磷酰胺(CTX)500 mg/m~2,D1、D8 Q28D;吡(柔)比星(THP)35 mg/m~2,D1、D8 Q28D;5氟尿嘧啶(5-Fu)200 mg·m~(-2)·d~(-1)持续静脉泵注(ci)D1-D28]方案新辅助化疗和84例完成4周期Tq1w(PTX60-80mg/m~2,D1、D8、D15 Q21D)方案新辅助化疗的原发性乳腺癌患者资料,应用受试者工作特征曲线(ROE曲线)分析,对以新辅助化疗2周期后超声影像测量的肿瘤最大垂直双径乘积变化预测4周期后病理Miller & Payne分级进行评价.结果 对以超声评效预测新辅助化疗无效、化疗显效和病理学完全缓解3种情况进行ROC曲线分析,其曲线下面积依次为0.689、0.655和0.647(P均<0.05).以传统超声评效<50%为标准预测新辅助化疗无效,或以超声评效≥50%为标准预测化疗显效,kappa值<0.40.结论 原发性乳腺癌CTFci4w或Tq1w方案新辅助化疗2周期后,单独以原发灶超声大小变化不能可靠预测化疗4周期后的病理评效结果.

Feasibility of predicting pathological evaluation by ultrasonic evaluation in initial stage of neoadjuvant chemotherapy for primary breast cancer

Objective To investigate the correlation between change of tumor size after 2 cycles of neoadjuvant chemotherapy and pathological evaluation after 4 cycles of neoadjuvant chemotherapy. And to evaluate the feasibility of predicting pathological evaluation by ultrasonic evaluation in the initial stage of neoadjuvant chemotherapy for primary breast cancer. MethodsRetrospective analysis was performed in women with primary breast cancer,including 138 patients receiving 4 cycles of anthracycline-based neuadjuvant chemotherapy (CTX500 mg/m~2, D1, D8 Q28D; THP35 mg/m~2, D1, D8 Q28D; 5-Fu200 mg/m~2/day, ci D1-D28), and 84 patients receiving 4 cycles of taxane-based neoadjuvant chemotherapy (PTX60-80mg/m~2, D1, D8, D15 Q21D). The ROC (receiver operating characteristic) curve was employed to evaluate whether the product change of 2 largest perpendicular diameters of tumor as observed by ultrasonography after 2 cycles of neoadjuvant chemotherapy could exactly predict the pathologic evaluation by the Miller & Payne grading system criteria after 4 cycles of neoadjuvant chemotherapy. Results When no response, excellent response or pathologic complete remission to neoadjuvant chemotherapy were predicted by ultrasonic evaluation. And the areas under the curve ROC were 0. 689, 0. 655 and 0. 647 respectively (all P values <0. 05). It was predicted as no response by using the traditional standard of ultrasonic evaluation of <50% or excellent response at ≥ 50% ( kappa<0. 40 ). ConclusionPathological evaluation after 4 cycles of anthracycline- or taxane-basecl primary chemotherapy in breast cancer can't be predicted reliably only by the product change of 2 largest perpendicular diameters of tumor as observed by ultrasound after 2 cycles of neoadjuvant chemotherapy.