【摘要】 目的 研究双靶新辅助治疗人表皮生长因子受体-2(HER-2)阳性乳腺癌的疗效及磁共振成像(MRI)参数变化。方法 选取2019年1月～2020年3月于本院收治的112例乳腺癌患者，根据治疗方式分为TCH组[曲妥珠单抗(H)+多西他赛(T)+卡铂(C)]和TCHP组[曲妥珠单抗(H)+帕妥珠单抗(P)+多西他赛(T)+卡铂(C)],各56例。随访1年，比较两组的MRI检查疗效、病理疗效和1年生存率；比较不同疗效患者的MRI检查结果；采用ROC曲线分析MRI各序列参数对HER-2阳性乳腺癌病理完全缓解(pCR)的预测价值；采用Kaplan-Meier法绘制分析不同疗效患者的1年生存率曲线。结果 TCHP组的MRI检测有效率高于TCH组(P<0.05);TCHP组的病理检测有效率高于TCH组(P<0.05)。非pCR与pCR患者的表观弥散系数(ADC)值、肿瘤最大长径、EER、TIC、强化模式比较差异均有统计学意义(均P<0.05)。ADC值、肿瘤最大长径、EER预测HER-2阳性乳腺癌患者pCR的AUC为0.891(95%CI:0.818～0.942),且联合预测的AUC高于单一预测(P<0.05)。TCHP组患者的1年生存率高于TCH组(χ~2=4.192,P=0.041)。结论 TCHP新辅助治疗HER-2阳性乳腺癌患者疗效良好，1年生存率高，安全性强，联合ADC值、肿瘤最大长径、EER进行评估，可有效提高患者pCR的预测价值。更多还原

【Abstract】 Objective To study the curative effect of dual-target neoadjuvant therapy on human epidermal growth factor receptor-2(HER-2) positive breast cancer and the changes of magnetic resonance imaging(MRI) parameters.Methods A total of 112 breast cancer patients admitted to the hospital from January 2019 to March 2020 were enrolled and divided into TCH group[trastuzumab(H), taxotere(T), carboplatin(C)] and TCHP group[trastuzumab(H), pertuzumab(P), taxotere(T), carboplatin(C)] according to different treatment methods, 56 cases in each group. They were followed up for 1 year. MRI and pathological efficacy, and 1-year survival rate between the two groups were compared. MRI examination results in patients with different curative effect were compared. The predictive value of the MRI parameters for pCR of patients with HER-2 positive breast cancer was analyzed by ROC curves. The curves of 1-year survival rate in patients with different curative effect were analyzed by Kaplan-Meier method.Results The response rate of MRI detection in TCHP group was higher than that in TCH group(78.57% vs 60.71%)(P<0.05), and response rate of pathological detection was higher than that in TCH group(82.14% vs 58.93%)(P<0.05). The differences in apparent diffusion coefficient(ADC), tumor maximum diameter, EER, TIC and enhancement mode between patients without or with pathological complete response(pCR) were statistically significant(P<0.05).AUC of ADC combined with tumor maximum diameter and EER for predicting pCR of patients with HER-2 positive breast cancer was 0.891(95%CI: 0.818-0.942).AUC of combined prediction was higher than that of single index(P<0.05). The 1-year survival rate in TCHP group was higher than that in TCH group(92.73% vs 78.78%)((~2=4.192, P=0.041).Conclusion Curative effect of TCHP neoadjuvant therapy is significant on patients with HER-2 positive breast cancer, with high 1-year survival rate and high safety. MRI signs indicate that the combined assessment of ADC, tumor maximum diameter and EER can effectively improve the predictive value for pCR.更多还原