本文選題：血氧功能成像 + 乳腺癌��； 參考：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討血氧功能成像在乳腺癌新輔助化療療效評(píng)估的應(yīng)用價(jià)值。方法:采用乳腺血氧功能系統(tǒng)檢測(cè)20例乳腺癌患者新輔助化療前、后乳腺腫瘤組織血、氧含量,每一周期化療前檢測(cè)腫瘤血、氧含量,每化療2個(gè)周期行MRI測(cè)量腫瘤大小,按實(shí)體瘤的療效評(píng)價(jià)標(biāo)準(zhǔn)(RECIST)評(píng)估療效1次,化療4周期后行手術(shù)治療。通過(guò)免疫組化檢測(cè)腫瘤組織CD34的表達(dá)水平測(cè)量化療前的腫瘤組織、術(shù)后腫瘤組織微血管密度(MVD)。依Miller和Payne分級(jí)系統(tǒng)進(jìn)行病理評(píng)價(jià)。分析微血管密度變化與血、氧值變化的相關(guān)性。并根據(jù)結(jié)果分析血氧功能成像評(píng)估新輔助化療的價(jià)值。結(jié)果:20例乳腺癌患者新輔助化療結(jié)束后依據(jù)臨床療效評(píng)價(jià)指標(biāo)測(cè)定腫瘤最大直徑,治療后4例完全緩解(CR),8例為部分緩解(PR);6例為疾病穩(wěn)定(SD);2例疾病進(jìn)展(PD)。PR及CR為有反應(yīng)組12例;PD及SD為無(wú)反應(yīng)組8例。依據(jù)Miller-Payne分級(jí)系統(tǒng)進(jìn)行病理評(píng)價(jià),對(duì)比臨床評(píng)估發(fā)現(xiàn)兩者在新輔助化療療效評(píng)估中的一致性。本研究中,化療前與4周期后比較,有反應(yīng)組腫瘤血值(中位數(shù))-0.7701,變化至-0.3713,氧值(中位數(shù))由0.4884升高至0.6745,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。有反應(yīng)組的腫瘤MVD由化療前27.84/視野降至14.67/視野,化療前后差異有統(tǒng)計(jì)學(xué)意義(p=0.011)。無(wú)反應(yīng)組的血值(中位數(shù))-0.8769變化至-0.4047,氧值(中位數(shù))由0.4884變化至0.5438,但血值、氧值變化無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。無(wú)反應(yīng)組的腫瘤MVD由化療前20.84/視野升高至23.17/視野,差異無(wú)統(tǒng)計(jì)學(xué)意義(p=0.44)。有反應(yīng)組與無(wú)反應(yīng)組比較,腫瘤MVD的差異有統(tǒng)計(jì)學(xué)意義。同時(shí)發(fā)現(xiàn),新輔助化療4周期腫瘤組織的血值變化與MVD變化呈正相關(guān),而腫瘤組織內(nèi)氧值變化與MVD變化呈負(fù)相關(guān)。結(jié)論:乳腺血氧功能成像檢測(cè)乳腺癌新輔助化療后腫瘤組織的血值、氧值的變化,一定程度能反映化療的療效,功能與形態(tài)相結(jié)合的評(píng)估可能更好地反應(yīng)腫瘤對(duì)化療的反應(yīng)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.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.9

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