| 摘要: |
| 目的：通过声脉冲触诊组织定量技术（VTQ）来判定乳腺癌新辅助化疗残存灶的价值。
材料和方法：
31例确诊乳腺癌Ⅱ-Ⅲ期行新辅助化疗(NAC)的患者纳入研究；在NAC前后分别进行常规超声和VTQ检查，常规超声评价参照实体瘤治疗疗效评价标准（RECIST 1.1）测量NAC前后肿瘤大小变化率，VTQ评价指标包括病灶中央、病灶边缘VTQ值，以及病灶中央、病灶边缘与周围脂肪组织VTQ值比值,NAC后VTQ值减少≥30％定义为有效(完全缓解CR+部分缓解PR)，<30%定义为稳定（SD），增加定义为进展(PD)。NAC疗效的病理学评价采用Miller-Payne系统，其中CR+PR对应病理学显著反应（G4+G5），SD+PD定义为非病理学显著反应(G1+G2 +G3)。对上述参数行多因素回归分析，分析NAC病理学显著反应的影响因素；采用配对T检验比较NAC前后肿瘤中央VTQ值、边缘VTQ值、相应VTQ比值、肿瘤大小有无差异；采用独立样本t检验分别比较NAC前、后病理反应显著与病理反应非显著组之间VTQ值有无差异；采用Kappa检验分析常规超声、VTQ技术与组织病理学判断NAC疗效的一致性；采用ROC分析肿瘤缩小率、肿瘤VTQ值缩小率以及二者联合评价NAC效能。
结果：
NAC病理学显著反应影响因素的多变量回归分析发现，化疗前后肿瘤中央VTQ差值、患者年龄是独立预测因子。配对T检验发现NAC前后肿瘤中央VTQ值、边缘VTQ值、VTQ比值、肿瘤大小有差异（P值分别为0.000，0.000，0.009，0.000），NAC后显著反应和非显著反应组间肿瘤中央以及肿瘤边缘VTQ值及其与周围脂肪的VTQ值比值存在统计学差异（P值分别为0.000,0.001,0.013,0.038）；NAC前后肿瘤的大小变化率、肿瘤中央和边缘VTQ值的变化率和Miller-Payne系统分级的一致性检验的kappa值分别为0.322,0.695,0.563；肿瘤大小缩小率、肿瘤VTQ值缩小率以及联合二者评价NAC效果的ROC曲线下面积分别为0.655,0.905,0.909 （肿瘤中央）和0.655,0.734,0.756（肿瘤边缘）。
结论：
通过测量肿瘤中央和边缘区的VTQ值变化是评价乳腺癌NAC疗效的一种可行的有效方法；单独测量肿瘤大小缩小率来评价NAC病理学缓解准确性较低；联合VTQ技术后可以提高诊断效能。 |
| 关键词: 声脉冲触诊组织定量技术,新辅助化疗,ROC分析,乳腺癌,Miller-Payne系统 |
| DOI： |
| 投稿时间：2017-06-14修订日期：2017-07-19 |
| 基金项目:江苏省卫生厅面上项目(H201445)；苏州市肿瘤临床医学中心(Szzx201506)。 |
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| The efficacy of virtual touth quantification in evaluating neoadjuvant cheomotherapy on breast cancer |
| Guo jianfeng |
| (Affiliated Su zhou Hospital of Nanjing Medical University,Suzhou Municipal Hospital [East Area]) |
| Abstract: |
| Objective:To assess the virtual touth quantification(VTQ) in evaluating the efficacy of neoadjuvant cheomotherapy(NAC) on breast cancer.
Methods:Thirty-one clinical stage II-III breast cancer patients were enrolled in the study which underwent neoadjuvant cheomotherapy.All patients underwent traditional ultrasound,VTQ and pathologic evaluations.the response evaluation criteria in solid tumors(RECIST 1.1)were used to evaluate the traditional ultrasonic efficacy.Then,VTQ were underwent before and after NAC.The ultrasonic evalating criteria were the tumor size reduction rate,the VTQ value of the tumor center(VTQcenter),the VTQ value of the tumor margin(VTQmargin),the VTQ Ratio of tumor center to fat(VTQRcenter/fat), the VTQ Ratio of margin to fat (VTQRmargin/fat).The response of NAC was defined as effective(CR+PR)if the reduction rate of VTQ value≥30％；stable disease(SD) if the reduction rate of VTQ value value<30％；progressive disease(PD) if VTQ value value increase．The Miller-Payne grading system was used to evaluate the pathologic response;CR+PR correlated with major pathologic response(MHR= G4+G5)；SD+PD correlated with non major pathologic response(NMHR=G1+G2+ G3)．Then,the multiple regression analysis were used to analyse the influence factor of NAC efficacy; the paired t-test were used to compare the VTQ value pre-NAC and post-NAC;the t-test were used to analyze the tumor size and VQT value reduction rate after NAC between the MHR and NMHR groups;The agreement of NAC response between traditional ultrasound,VTQ and hispathological results was measured using Kappa statistics. At last,the efficacy of tumor size,the VTQ value reduction rate and the combination in the evaluation of NAC were compared by ROC analysis.
Results:1.the multiple regression analysis found that the age and the tumor center VTQ value before and after NAC were the independent predictors.2.Compared with the pre-NAC value,the VTQcenter,VTQmargin,VTQRcenter/fat,VTQRmargin/fat and the tumor size after NAC had statistical significance(the P value were 0.000,0.000,0.012,0.000,0.000 respectively).3.After NAC,the VTQcenter,VTQmargin,VTQRcenter/fat,VTQRmargin/fat between the MHR and NMHR groups had statistical significance(the P value were 0.000,0.001,0.013,0.038 respectively).4.The agreement between tumor size reduction rate,the reduction rate of VTQcenter,VTQmargin with Miller-Payne grading system were 0.322,0.695,0.563 respectively(P<0.05).5.The area under the ROC curve of tumor size reduction rate,the reduction rate of VTQ value and the combination of both were 0.655,0.905,0.909（center）and 0.655,0.734,0.756(margin) respectively(P<0.05) in the evaluation of the NAC efficacy.
Conclusion :The VTQ value differences is an effective method to assess the efficacy of NAC.The accuracy of measuring the tumor size is relatively low;combined with the VTQ technique,the efficacy can be effectively improved. |
| Key words: neoadjuvant cheomotherapy , virtual touth quantification ,breast cancer, Miller-Payne grading system, ROC analysis |
