乳腺血氧功能成像在乳腺癌新辅助化疗疗效评估中的应用探讨

发布时间：2018-04-12 07:36

本文选题：血氧功能成像 + 乳腺癌　；参考：《广西医科大学》2017年硕士论文

【摘要】：目的:探讨血氧功能成像在乳腺癌新辅助化疗疗效评估的应用价值。方法:采用乳腺血氧功能系统检测20例乳腺癌患者新辅助化疗前、后乳腺肿瘤组织血、氧含量,每一周期化疗前检测肿瘤血、氧含量,每化疗2个周期行MRI测量肿瘤大小,按实体瘤的疗效评价标准(RECIST)评估疗效1次,化疗4周期后行手术治疗。通过免疫组化检测肿瘤组织CD34的表达水平测量化疗前的肿瘤组织、术后肿瘤组织微血管密度(MVD)。依Miller和Payne分级系统进行病理评价。分析微血管密度变化与血、氧值变化的相关性。并根据结果分析血氧功能成像评估新辅助化疗的价值。结果:20例乳腺癌患者新辅助化疗结束后依据临床疗效评价指标测定肿瘤最大直径,治疗后4例完全缓解(CR),8例为部分缓解(PR);6例为疾病稳定(SD);2例疾病进展(PD)。PR及CR为有反应组12例;PD及SD为无反应组8例。依据Miller-Payne分级系统进行病理评价,对比临床评估发现两者在新辅助化疗疗效评估中的一致性。本研究中,化疗前与4周期后比较,有反应组肿瘤血值(中位数)-0.7701,变化至-0.3713,氧值(中位数)由0.4884升高至0.6745,差异均有统计学意义(P0.05)。有反应组的肿瘤MVD由化疗前27.84/视野降至14.67/视野,化疗前后差异有统计学意义(p=0.011)。无反应组的血值(中位数)-0.8769变化至-0.4047,氧值(中位数)由0.4884变化至0.5438,但血值、氧值变化无统计学意义(P0.05)。无反应组的肿瘤MVD由化疗前20.84/视野升高至23.17/视野,差异无统计学意义(p=0.44)。有反应组与无反应组比较,肿瘤MVD的差异有统计学意义。同时发现,新辅助化疗4周期肿瘤组织的血值变化与MVD变化呈正相关,而肿瘤组织内氧值变化与MVD变化呈负相关。结论:乳腺血氧功能成像检测乳腺癌新辅助化疗后肿瘤组织的血值、氧值的变化,一定程度能反映化疗的疗效,功能与形态相结合的评估可能更好地反应肿瘤对化疗的反应程度。
[Abstract]:Objective: to evaluate the value of oxygenation imaging in evaluating the efficacy of neoadjuvant chemotherapy in breast cancer.Methods: the blood and oxygen contents of breast cancer tissue were measured by mammary blood oxygen function system before and after neoadjuvant chemotherapy in 20 patients with breast cancer. The tumor blood and oxygen content were measured before each cycle of chemotherapy, and the tumor size was measured by MRI every 2 cycles of chemotherapy.The therapeutic effect was evaluated once according to the evaluation criteria of solid tumor, and the operation was performed after 4 cycles of chemotherapy.The expression of CD34 in tumor tissue was detected by immunohistochemistry. The microvessel density of tumor tissue was measured before chemotherapy and after operation.Pathological evaluation was performed according to Miller and Payne grading system.To analyze the correlation between the change of microvessel density and the change of blood and oxygen value.The value of blood oxygen function imaging in evaluating neoadjuvant chemotherapy was analyzed based on the results.Results after neoadjuvant chemotherapy in 20 breast cancer patients, the maximum diameter of the tumor was measured according to the clinical curative effect evaluation index.After treatment, there were 8 cases of complete remission of CRD and 8 cases of partial remission of PRD. 6 cases were stable disease and 2 cases of disease progression. PR and CR were 12 cases of PD and 8 cases of non-response group.According to the Miller-Payne grading system, the clinical evaluation showed the consistency of the two in the evaluation of neoadjuvant chemotherapy efficacy.In this study, before and after 4 cycles of chemotherapy, the tumor blood value (median value: -0.7701, change to -0.3713), oxygen value (median) increased from 0.4884 to 0.6745 in the response group, the difference was statistically significant (P 0.05).The tumor MVD in the response group was decreased from 27.84 / visual field to 14.67 / visual field before and after chemotherapy, and the difference was statistically significant before and after chemotherapy.In the non-response group, the blood value (median) changed from -0.8769 to -0.4047, and the oxygen value (median) changed from 0.4884 to 0.5438, but there was no significant difference in blood value and oxygen value (P 0.05).The tumor MVD in the non-response group increased from 20.84 / visual field to 23.17 / visual field before chemotherapy, and there was no significant difference between the two groups.The difference of tumor MVD between response group and non-response group was statistically significant.At the same time, it was found that the blood value of neoadjuvant chemotherapy was positively correlated with the change of MVD, while the change of oxygen in neoadjuvant chemotherapy was negatively correlated with the change of MVD.Conclusion: the changes of blood value and oxygen value of breast cancer tissue after neoadjuvant chemotherapy can reflect the effect of chemotherapy to some extent.The evaluation of function and morphology may better reflect the degree of tumor response to chemotherapy.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9

【参考文献】