Abstract：
OBJECTIVE: To explore the independent and additional value of oedema and shrinkage patterns for predicting the disease-free survival (DFS) and neoadjuvant chemotherapy (NAC) response in luminal breast cancer (BC).
METHODS: Patients with luminal BC who underwent NAC were enrolled in this study from 2017 to 2022. Traditional MRI features include BI-RADS-based MRI descriptors, tumor size, and ADC values, while emerging MRI features include oedema and shrinkage patterns, all of which were evaluated before, early, and after NAC. The changes in features during NAC were also evaluated. The value of features was evaluated through univariate, multivariate analyses.
RESULTS: A total of 258 patients were enrolled in this study, of which 77 responded to NAC. Diffuse oedema, stable or increased oedema during early NAC were adverse predictors for treatment response, while a greater reduction in tumor size and increase in ADC value were favorable predictors (all P<0.05). Furthermore, 20 of 60 patients who were followed up experienced recurrence. Diffuse oedema, pre-pectoral or subcutaneous oedema, and non-concentric shrinkage patterns after NAC were risk factors for DFS, whereas a greater increase in ADC value was a protective factor. Incorporating oedema and shrinkage patterns into traditional MRI features improved the predictive performance for treatment response (AUC from 0.76-0.78 to 0.80-0.83) and DFS (C-index from 0.67-69 to 0.75-0.80).
CONCLUSIONS: Oedema is an unfavorable predictor for treatment response and survival outcomes, while shrinkage patterns contribute more to the prognostic value, both of which could offer supplementary benefits for clinical outcomes in luminal BC.
METHODS: Patients with luminal BC who underwent NAC were enrolled in this study from 2017 to 2022. Traditional MRI features include BI-RADS-based MRI descriptors, tumor size, and ADC values, while emerging MRI features include oedema and shrinkage patterns, all of which were evaluated before, early, and after NAC. The changes in features during NAC were also evaluated. The value of features was evaluated through univariate, multivariate analyses.
RESULTS: A total of 258 patients were enrolled in this study, of which 77 responded to NAC. Diffuse oedema, stable or increased oedema during early NAC were adverse predictors for treatment response, while a greater reduction in tumor size and increase in ADC value were favorable predictors (all P<0.05). Furthermore, 20 of 60 patients who were followed up experienced recurrence. Diffuse oedema, pre-pectoral or subcutaneous oedema, and non-concentric shrinkage patterns after NAC were risk factors for DFS, whereas a greater increase in ADC value was a protective factor. Incorporating oedema and shrinkage patterns into traditional MRI features improved the predictive performance for treatment response (AUC from 0.76-0.78 to 0.80-0.83) and DFS (C-index from 0.67-69 to 0.75-0.80).
CONCLUSIONS: Oedema is an unfavorable predictor for treatment response and survival outcomes, while shrinkage patterns contribute more to the prognostic value, both of which could offer supplementary benefits for clinical outcomes in luminal BC.
摘要：
目的：探讨水肿和收缩模式对预测管腔乳腺癌（BC）无病生存（DFS）和新辅助化疗（NAC）反应的独立和附加价值。
方法：从2017年至2022年，本研究纳入了接受NAC的管腔BC患者。传统的MRI特征包括基于BI-RADS的MRI描述符，肿瘤大小,和ADC值，虽然新出现的MRI特征包括水肿和收缩模式，所有这些都是之前评估过的，早期，在NAC之后。还评估了NAC期间特征的变化。通过单变量评估特征的价值，多变量分析。
结果：本研究共纳入258例患者，其中77人回应了NAC。弥漫性水肿,NAC早期水肿稳定或增加是治疗反应的不良预测因子，而肿瘤大小的减小和ADC值的增加是有利的预测因素（均P<0.05）。此外，60例随访患者中有20例出现复发。弥漫性水肿,胸前或皮下水肿，NAC后的非同心收缩模式是DFS的危险因素，而ADC值的增加是一个保护因素。将水肿和收缩模式纳入传统MRI特征可改善治疗反应的预测性能（AUC从0.76-0.78到0.80-0.83）和DFS（C指数从0.67-69到0.75-0.80）。
结论：水肿是治疗反应和生存结局的不利预测因素，虽然收缩模式对预后价值贡献更大，两者都可以为管腔BC的临床结局提供补充益处.
方法：从2017年至2022年，本研究纳入了接受NAC的管腔BC患者。传统的MRI特征包括基于BI-RADS的MRI描述符，肿瘤大小,和ADC值，虽然新出现的MRI特征包括水肿和收缩模式，所有这些都是之前评估过的，早期，在NAC之后。还评估了NAC期间特征的变化。通过单变量评估特征的价值，多变量分析。
结果：本研究共纳入258例患者，其中77人回应了NAC。弥漫性水肿,NAC早期水肿稳定或增加是治疗反应的不良预测因子，而肿瘤大小的减小和ADC值的增加是有利的预测因素（均P<0.05）。此外，60例随访患者中有20例出现复发。弥漫性水肿,胸前或皮下水肿，NAC后的非同心收缩模式是DFS的危险因素，而ADC值的增加是一个保护因素。将水肿和收缩模式纳入传统MRI特征可改善治疗反应的预测性能（AUC从0.76-0.78到0.80-0.83）和DFS（C指数从0.67-69到0.75-0.80）。
结论：水肿是治疗反应和生存结局的不利预测因素，虽然收缩模式对预后价值贡献更大，两者都可以为管腔BC的临床结局提供补充益处.
