Radiologic complete response (rCR) in contrast-enhanced magnetic resonance imaging (CE-MRI) after neoadjuvant chemotherapy for early breast cancer predicts recurrence-free survival but not pathologic complete response (pCR)

被引：61

作者：

Gampenrieder, Simon Peter ^{[1
,2
,3
]}

Peer, Andreas ^{[1
,2
]}

Weismann, Christian ^{[4
]}

Meissnitzer, Matthias ^{[4
]}

Rinnerthaler, Gabriel ^{[1
,2
,3
]}

Webhofer, Johanna ^{[1
,2
]}

Westphal, Theresa ^{[1
,2
]}

Riedmann, Marina ^{[5
]}

Meissnitzer, Thomas ^{[4
]}

Egger, Heike ^{[4
]}

Federspiel, Frederike Klaassen ^{[6
,7
]}

Reitsamer, Roland ^{[6
,7
]}

Hauser-Kronberger, Cornelia ^{[8
]}

Stering, Katharina ^{[8
]}

Hergan, Klaus ^{[4
]}

Mlineritsch, Brigitte ^{[1
,2
]}

Greil, Richard ^{[1
,2
,3
]}

机构：

[1] Paracelsus Med Univ, Dept Internal Med Hematol 3, Oncol Ctr, Med Oncol Hemostaseol Infectiol & Rheumatol, Salzburg, Austria

[2] Paracelsus Med Univ, SCRI LIMCR, Salzburg, Austria

[3] Canc Cluster Salzburg, Salzburg, Austria

[4] Paracelsus Med Univ Salzburg, Dept Radiol, Salzburg, Austria

[5] Med Univ Innsbruck, Dept Med Stat Informat & Hlth Econ, Innsbruck, Austria

[6] Paracelsus Med Univ Salzburg, Dept Special Gynecol, Salzburg, Austria

[7] Paracelsus Med Univ Salzburg, Breast Ctr, Salzburg, Austria

[8] Paracelsus Med Univ Salzburg, Dept Pathol, Salzburg, Austria

来源：

BREAST CANCER RESEARCH | 2019年 / 21卷 / 1期

关键词：

Breast cancer; MRI; Neoadjuvant chemotherapy; Prediction of complete pathologic response; Survival; DIAGNOSTIC PERFORMANCE; METAANALYSIS;

D O I：

10.1186/s13058-018-1091-y

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

BackgroundPatients with early breast cancer (EBC) achieving pathologic complete response (pCR) after neoadjuvant chemotherapy (NACT) have a favorable prognosis. Breast surgery might be avoided in patients in whom the presence of residual tumor can be ruled out with high confidence. Here, we investigated the diagnostic accuracy of contrast-enhanced MRI (CE-MRI) in predicting pCR and long-term outcome after NACT.MethodsPatients with EBC, including patients with locally advanced disease, who had undergone CE-MRI after NACT, were retrospectively analyzed (n=246). Three radiologists, blinded to clinicopathologic data, reevaluated all MRI scans regarding to the absence (radiologic complete remission; rCR) or presence (no-rCR) of residual contrast enhancement. Clinical and pathologic responses were compared categorically using Cohen's kappa statistic. The Kaplan-Meier method was used to estimate recurrence-free survival (RFS) and overall survival (OS).ResultsOverall rCR and pCR (no invasive tumor in the breast and axilla (ypT0/is N0)) rates were 45% (111/246) and 29% (71/246), respectively. Only 48% (53/111; 95% CI 38-57%) of rCR corresponded to a pCR (= positive predictive value - PPV). Conversely, in 87% (117/135; 95% CI 79-92%) of patients, residual tumor observed on MRI was pathologically confirmed (= negative predictive value - NPV). Sensitivity to detect a pCR was 75% (53/71; 95% CI 63-84%), while specificity to detect residual tumor and accuracy were 67% (117/175; 95% CI 59-74%) and 69% (170/246; 95% CI 63-75%), respectively. The PPV was significantly lower in hormone-receptor (HR)-positive compared to HR-negative tumors (17/52=33% vs. 36/59=61%; P=0.004). The concordance between rCR and pCR was low (Cohen's kappa -0.1), however in multivariate analysis both assessments were significantly associated with RFS (rCR P=0.037; pCR P=0.033) and OS (rCR P=0.033; pCR P=0.043).ConclusionPreoperative CE-MRI did not accurately predict pCR after NACT for EBC, especially not in HR-positive tumors. However, rCR was strongly associated with favorable RFS and OS.

引用

页数：11

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