【摘要】 目的 观察乳腺癌患者系统性治疗后1年内局部区域复发（loco-regional recurrence, LRR）情况，探讨超声剪切波弹性成像（shear wave elastography, SWE）定量参数对乳腺癌患者系统性治疗后1年内发生LRR的预测价值。方法120例乳腺癌患者均给予系统性治疗（新辅助化疗+单纯乳房切除术+术后放疗等）,治疗后随访1年，根据是否发生LRR分为复发组30例和未复发组90例；乳腺良性结节患者60例为对照组。3组患者均行乳腺常规超声和实时SWE检查，比较3组乳腺常规超声声像特征及SWE定量参数[病灶及病灶周围1、2、3 mm范围内最大弹性模量值（maximum elastic modulus, Emax）,分别记为A-Emax、Shell1Emax、Shell2Emax、Shell3Emax],比较复发组与未复发组肿瘤直径、淋巴结转移等临床病理特征；采用多因素logistic回归分析乳腺癌患者系统性治疗后1年内发生LRR的影响因素；绘制ROC曲线，评估SWE定量参数预测乳腺癌患者系统性治疗后1年内发生LRR的效能。结果 复发组形态不规则、边缘不规整、回声不均匀、无包膜比率（96.67%、90.00%、96.67%、93.33%）及A-Emax、Shell1Emax、Shell2Emax、Shell3Emax[（130.23±14.25）、（166.84±17.52）、（173.39±18.54）、（174.89±18.56）kPa]均高于未复发组[78.89%、68.89%、81.11%、75.56%、（121.51±13.47）kPa、（158.48±16.22）kPa、（162.99±18.43）kPa、（163.89±17.84）kPa)]、对照组[21.67%、18.33%、33.33%、16.67%、（86.58±9.24）kPa、（98.86±10.62）kPa、（108.86±12.15）kPa、（112.39±13.21）kPa]（P<0.05）,未复发组均高于对照组（P<0.05）。复发组肿瘤直径>3 cm、有淋巴结转移、人表皮生长因子受体-2表达阳性、病理N分期ypN_2-3期、新辅助化疗周期数≤6个比率（53.33%、66.67%、66.67%、50.00%、60.00%）均高于未复发组（30.00%、41.11%、40.00%、24.44%、37.78%）（P<0.05）。肿瘤直径>3 cm（OR=2.236,95%CI:1.121～4.368,P<0.001）、有淋巴结转移（OR=1.854,95%CI:1.286～3.784,P<0.001）、人表皮生长因子受体-2表达阳性（OR=2.347,95%CI:1.481～5.227,P<0.001）、A-Emax（OR=4.021,95%CI:2.237～6.156,P<0.001）、Shell1Emax（OR=2.239,95%CI:1.527～3.249,P=0.029）、Shell2Emax（OR=2.186,95%CI:1.714～3.647,P=0.032）、Shell3Emax（OR=2.864,95%CI:1.128～4.315,P<0.001）是乳腺癌患者系统性治疗后1年内发生LRR的影响因素。A-Emax、Shell1Emax、Shell2Emax、Shell3Emax分别以125、163、166、168 kPa为最佳截断值，单独及联合预测乳腺癌患者系统性治疗后1年内发生LRR的AUC分别为0.738（95%CI:0.639～0.838,P<0.001）、0.777（95%CI:0.679～0.876,P<0.001）、0.775（95%CI:0.688～0.862,P<0.001）、0.750（95%CI:0.658～0.841,P<0.001）、0.881（95%CI:0.807～0.956,P<0.001）,灵敏度分别为73.3%、80.0%、76.7%、74.6%、73.3%,特异度分别为77.0%、57.8%、65.6%、66.4%、87.8%;4项参数联合预测的AUC均大于单独预测（P<0.05）。结论 肿瘤直径>3 cm、有淋巴结转移、人表皮生长因子受体-2表达阳性及A-Emax、Shell1Emax、Shell2Emax、Shell3Emax增高的乳腺癌患者系统性治疗后1年内发生LRR的风险较大，SWE定量参数联合预测乳腺癌患者系统性治疗后1年内发生LRR有较高价值。更多还原

【Abstract】 Objective To observe loco-regional recurrence(LRR) of breast cancer within 1 year after systemic treatment, and to investigate the value of quantitative parameters of shear wave elastography(SWE) to the prediction of LRR.Methods Totally 120patients with breast cancer were given systematic therapy(neoadjuvant chemotherapy +simple mastectomy+ postoperative radiotherapy,etc.),and were divided into LRR group(n=30)and no-LRR group(n=90)according to the 1-year follow-up result.Another 60patients with benign breast nodules were as controls(control group).Three groups underwent conventional breast ultrasound and real-time SWE examination,and were compared the sonographic characteristics of breast ultrasound and quantitative SWE parameters [maximum elastic modulus(Emax)within 1,2and 3 mm of the lesion and its surrounding area,denoted as A-Emax,Shell1Emax,Shell2Emax and Shell3Emax].The tumor diameter,lymph node metastasis and other clinicopathological characteristics were compared between two groups.The influencing factors of LRR within 1year after systemic therapy were analyzed by multivariate logistic regression in breast cancer patients.ROC curves were plotted to evaluate the efficiency of quantitative SWE parameters on predicting LRR.Results The percentages of patients with morphological irregularity,marginal irregularity,echogenicity and absence of envelope,as well as the values of A-Emax and Shell1Emax,Shell2Emax and Shell3Emax were higher in LRR group[96.67%,90.00%,96.67%,93.33%;(130.23±14.25)kPa,(166.84±17.52)kPa,(173.39±18.54)kPa,(174.89±18.56)kPa]than those in no-LRR group[78.89%,68.89%,81.11%,75.56%;(121.51±13.47)kPa,(158.48±16.22)kPa,(162.99±18.43)kPa,(163.89±17.84)kPa]and control group [21.67%,18.33%,33.33%,16.67%;(86.58 ± 9.24)kPa,(98.86 ± 10.62)kPa,(108.86±12.15)kPa,(112.39±13.21)kPa](P<0.05),and higher in no-LRR group than those in control group(P<0.05).The percentages of patients with tumor diameter >3cm,lymph node metastasis,positive expression of human epidermal growth factor receptor-2,pathological N-stage ypN2-3,and neoadjuvant chemotherapy cycle≤6cycles were higher in LRR group(53.33%,66.67%,66.67%,50.00%,60.00%)than those in no-LRR group(30.00%,41.11%,40.00%,24.44%,37.78%)(P<0.05).The tumor diameter>3cm(OR=2.236,95%CI:1.121-4.368,P<0.001),lymph node metastasis(OR=1.854,95%CI:1.286-3.784,P<0.001),positive expression of human epidermal growth factor receptor-2(OR=2.347,95%CI:1.481-5.227,P<0.001),A-Emax(OR=4.021,95%CI:2.237-6.156,P<0.001),Shell1Emax(OR=2.239,95%CI:1.527-3.249,P=0.029),Shell2Emax(OR=2.186,95%CI:1.714-3.647,P=0.032)and Shell3Emax(OR=2.864,95%CI:1.128-4.315,P<0.001)were the influencing factors of LRR within 1year after systemic therapy of breast cancer.When the optimal cut-off values of A-Emax,Shell1Emax,Shell2Emax and Shell3Emax were 125,163,166and 168kPa,the AUCs of single and combined detection for predicting LRR within 1year after systemic therapy of breast cancer were 0.738(95%CI:0.639-0.838,P<0.001),0.777(95%CI:0.679-0.876,P<0.001),0.775(95%CI:0.688-0.862,P<0.001),0.750(95%CI:0.658-0.841,P<0.001),and 0.881(95%CI:0.807-0.956,P<0.001),the sensitivities were 73.3%,80.0%,76.7%,74.6% and73.3%,and the specificities were 77.0%,57.8%,65.6%,66.4%and 87.8%,respectively.The AUCof the combined detection of them four was greater than that of single detection(P<0.05).Conclusion Breast cancer patients with tumor diameter>3cm,lymph node metastasis,positive expression of human epidermal growth factor receptor-2and increased values of A-Emax,Shell1Emax,Shell2Emax and Shell3Emax have a high risk of LRR within 1year after systemic therapy,and the combined detection of the quantitative SWE parameters have a high predictive value.更多还原