本文選題：乳腺癌 + 新輔助化療　； 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討乳腺癌新輔助化療2周期后聯(lián)合動(dòng)態(tài)增強(qiáng)MRI(DCE-MRI)和擴(kuò)散加權(quán)成像(DWI)對(duì)預(yù)測(cè)病理反應(yīng)性的價(jià)值。方法:收集山西省腫瘤醫(yī)院2014年1月至2016年12月術(shù)前需行新輔助化療(NAC)的乳腺癌患者共48例,于新輔助化療(NAC)前、NAC第2周期后分別行兩次磁共振檢查并獲得DWI和DCE-MRI各參數(shù)數(shù)據(jù)。所有患者在治療前均經(jīng)穿刺活檢證實(shí),術(shù)后按病理結(jié)果分為組織學(xué)顯著反應(yīng)(MHR)組和非組織學(xué)顯著反應(yīng)(NMHR)組。對(duì)化療前兩組參數(shù)采用兩獨(dú)立樣本t檢驗(yàn),然后計(jì)算并評(píng)估表觀擴(kuò)散系數(shù)(ADC)、容量轉(zhuǎn)移常數(shù)(K~（trans）)、速率常數(shù)(K_(ep))的變化率,并通過Mann-Whitney U檢驗(yàn)評(píng)估MHR組和NMHR組間各參數(shù)變化率的差異。選擇ADC變化率和最佳DCE-MRI定量參數(shù)變化率建立Logistic回歸模型并構(gòu)建新參數(shù),以術(shù)后病理結(jié)果為金標(biāo)準(zhǔn),通過繪制受試者工作特征曲線(ROC)探究新構(gòu)建參數(shù)對(duì)預(yù)測(cè)乳腺癌新輔助化療療效的價(jià)值。結(jié)果:MHR組有11例,NMHR組37例。NAC前MHR組ADC、K~（trans）和K_(ep)值分別為774±104*10~(-6) mm~2/s、0.345±0.121 min~(-1)、0.925±0.30 min~(-1);NMHR組參數(shù)值分別為786±126 mm~2/s、0.347±0.157 min~(-1)、0.936±0.349 min~(-1),兩組間各參數(shù)均無統(tǒng)計(jì)學(xué)差異(t=-0.291,P=0.772;t=-0.055,P=0.956;t=-0.09,=0.928)。NAC 2周期后MHR組ADC、K~（trans）和K_(ep)變化率分別51.2%、-65.1%、-64.7%,NMHR組ADC、K~（trans）和K_(ep)變化率分別為31.2%、-11.8%、-24.9%,兩組間ADC、K~（trans）、K_(ep)變化率均有統(tǒng)計(jì)學(xué)差異。ADC、K~（trans）、K_(ep)變化率和新構(gòu)建聯(lián)合預(yù)測(cè)參數(shù)曲線下面積(area under curve,AUC)分別為0.774、0.850、0.823和0.894,曲線下面積最大者為新構(gòu)建聯(lián)合預(yù)測(cè)參數(shù)。結(jié)論:1、乳腺癌NAC 2周期后ADC、K~（trans）和K_(ep)變化率可以預(yù)測(cè)乳腺癌NAC的最終療效。2、聯(lián)合ADC和K~（trans）可以更準(zhǔn)確的預(yù)測(cè)乳腺癌NAC的療效。
[Abstract]:Objective: to evaluate the value of dynamic enhanced MRICE-MRI and diffusion weighted imaging (DWI) in predicting pathological reactivity after 2 cycles of neoadjuvant chemotherapy in breast cancer.Methods: from January 2014 to December 2016, 48 patients with breast cancer underwent neoadjuvant chemotherapy (NAC) before neoadjuvant chemotherapy. After the second cycle of neoadjuvant chemotherapy, two magnetic resonance examinations were performed and the parameters of DWI and DCE-MRI were obtained.All the patients were confirmed by biopsy before treatment. According to the pathological results, they were divided into two groups: histologically significant response group (MHRs) and non-histologically significant response group (NMHRs).Before chemotherapy, two independent samples t test were used to calculate and evaluate the change rate of apparent diffusion coefficient (ADCC), capacity transfer constant (K), rate constant (K), and to evaluate the difference between MHR group and NMHR group by Mann-Whitney U test.The Logistic regression model was established by selecting the rate of change of ADC and the rate of change of optimal quantitative parameters of DCE-MRI, and the new parameters were constructed. The results of postoperative pathology were taken as the golden standard.To explore the value of new construction parameters in predicting the therapeutic effect of neoadjuvant chemotherapy in breast cancer by drawing the operating characteristic curve of subjects.緇撴灉:MHR緇勬湁11渚，

本文編號(hào)：1767318