磁共振联合临床病理因素预测新辅助化疗后乳腺癌腋窝淋巴结转阴率

MRI Combining with Clinicopathological Factors Predict the Negative Rate of Axillary Lymph Nodes in Breast Cancer after Neoadjuvant Chemotherapy

摘要: 目的：探索磁共振成像(MRI)联合临床病理因素预测乳腺癌新辅助化疗(NAC)后腋窝淋巴结阳性患者降期为临床阴性的可行性。方法：回顾性收集2019年1月~2021年12月于青岛大学附属医院乳腺病诊疗中心完成新辅助化疗且新辅助化疗前腋窝淋巴结穿刺病理结果为阳性，至少具有新辅助化疗前磁共振影像学资料、新辅助化疗完成后的磁共振影像学资料，并于该中心接受腋窝淋巴结清扫的病人359例。比较术前肿块穿刺标本病理类型、Ki-67、MRI评估NAC前肿块大小、腋窝淋巴结分期、新辅助化疗后MRI评估肿块疗效、腋窝淋巴结疗效对新辅助化疗后腋窝淋巴结降期为临床阴性(ypN₀)的影响。结果：多因素分析显示，NAC前腋窝淋巴结分期、MRI评估NAC后肿块化疗反应、MRI评估NAC后淋巴结化疗反应、病理类型为影响NAC后ypN₀的独立预测因素，且HER-2过表达型乳腺癌NAC后ypN₀率最高、三阴性乳腺癌次之，Luminal型乳腺癌最低。结论：乳腺癌NAC前腋窝淋巴结分期早、NAC后经MRI评估肿块化疗反应达到CR、腋窝淋巴结化疗反应达到CR的病人，术后达到ypN0可能性更大，术前穿刺病理类型为HER-2阳性的病人术后达到ypN0的可能性最大，TNBC病人其次，Luminal型病人最小。

Abstract: Objectives: To investigate the feasibility of combining magnetic resonance imaging (MRI) with clinicopathological factors in predicting the downstaging of axillary lymph node-positive patients to clinically negative breast cancer after neoadjuvant chemotherapy (NAC). Methods: Retrospectively collecting 359 patients who received neoadjuvant chemotherapy at the breast disease treatment center of the Affiliated Hospital of Qingdao University from January 2019 to December 2021, all pa-tients had the pathological results of axillary lymph node before NAC, at least had MRI databefore and after NAC, and underwent axillary lymph node dissection in the center following the completion of NAC. The study compared the impact of preoperative biopsy pathological type, Ki-67, MRI-assessed tumor size and axillary lymph node stage prior to NAC, MRI-assessed response of the tumor andaxillary lymph nodes after NAC on the axillary lymph node downstaging to clinical nega-tivity (ypN₀) after NAC. Results: Multivariate analysis demonstrated that axillary lymph node stag-ing before NAC (OR = 1.863, P = 0.021), MRI-assessed tumor (OR = 0.353, P < 0.001) and lymph node chemotherapeutic response (OR = 0.301, P < 0.001) to chemotherapy after NAC, and patho-logical type were independent predictors of pathologically negative axillary lymph nodes after NAC (ypN₀), and the rate in human epidermal growth factor receptor 2 (HER-2) positive breast cancer was the highest (OR = 0.252, P < 0.001), followed by triple-negative breast cancer (TNBC), and Lu-minal breast cancer was the lowest (OR = 2.783, P = 0.015). Conclusions: Patients with early axillary lymph node staging prior to NAC, MRI-assessed tumor and axillary lymph node complete response (CR) after NAC are more likely to achieve ypN0. The patients with HER-2 positive biopsy type had the highest probability of achieving ypN0 thereafter surgery, followed by TNBC patients, and the least in Luminal patients.