乳腺癌对新辅助肌注睾酮-阿那曲唑治疗的快速反应的超声评估研究

摘要 目的：探究使用超声对接受肌注睾酮-阿那曲唑新辅助治疗（NAC）乳腺癌患者临床疗效评估的可行性，以期找出能够用于评估乳腺癌NAC疗效的可靠指标。方法：选择2018年1月至2021年1月于我院接受治疗的100例乳腺癌患者（100个病灶）为研究对象，分别于其接受化疗前和化疗后实施超声检测，记录入组患者二维超声指标（包括肿瘤形态、边界、内部回声、后方回声）、彩色多普勒超声指标（包括血流分级、血流阻力指数（RI）、收缩期最高血流速度（PSV））、超声弹性成像指标（包括弹性评分、弹性应变率（SR）），将入组患者按照化疗后病理结果区分为有效组（MHR组）和无效组（NMHR组），对比两组患者化疗前后上述参数的差异，分别对上述参数实施单因素和多因素Logistic回归分析，并通过绘制受试者工作特征曲线（ROC）的方式计算上述参数的诊断效能。结果：（1）定性参数方面，NAC治疗后MHR和NMHR组患者在病灶内部回声变化、血流分级变化、弹性评分变化方面具有差异（P<0.05）；定量参数方面，化疗结束后MHR组患者的RI、SR以及PSV均明显低于NMHR组（P<0.05）；（2）RI、SR以及PSV对乳腺癌患者接受肌注睾酮-阿那曲唑NAC治疗有效性的ROC曲线，其AUC分别为0.811（95% CI=0.666-0.957，P=0.002）、0.697（95% CI=0.524-0.869，P=0.038）、0.734（95% CI=0.570-0.897，P=0.011）；（3）单因素分析内部回声、血流分级、弹性评分、RI、SR以及PSV是乳腺癌患者NAC疗效影响因素，多因素Logistic回归分析RI、SR以及PSV会影响乳腺癌患者NAC疗效（P<0.05）。结论：超声在评估乳腺癌患者接受肌注睾酮-阿那曲唑NAC治疗有效性具有较好的应用价值，其中RI、SR及PSV可对乳腺癌NAC早期疗效做出可靠评估，可考虑将其应用于临床中。

Ultrasound Evaluation of Rapid Response of Breast Cancer to Neoadjuvant Intramuscular Injection of Testosterone-anastrozole

ABSTRACT Objective: To explore the feasibility of using ultrasound to evaluate the clinical efficacy of neoadjuvant chemotherapy (NAC) breast cancer patients receiving intramuscular injection of testosterone anastrozole, in order to identify reliable indicators that can be used to evaluate the efficacy of NAC in breast cancer. Methods: 100 patients with breast cancer(100 lesions) who received treatment in our hospital from January 2018 to January 2021 were selected as the research objects. They were subjected to ultrasonic examination before and after chemotherapy, and the two-dimensional ultrasound index(including tumor shape, border, internal echo, posterior echo) and color Doppler ultrasound index were recorded(including blood flow grade, blood flow resistance index (RI), maximum systolic blood flow velocity (PSV)), ultrasonic elastic imaging indexes (including elastic score and elastic strain rate(SR)), the patients were divided into effective group (MHR group) and ineffective group (nmhr group) according to the pathological results after chemotherapy Compare the difference of the above parameters between the two groups before and after chemotherapy, and carry out univariate and multivariate Logistic regression analysis to find out the indexes that can be applied to evaluate the efficacy of NAC in breast cancer patients, and calculate the diagnostic efficiency of these parameters by drawing ROC curve. Results: (1) In terms of qualitative parameters, there was difference between MHR and nmhr groups in the changes of internal echo, blood flow grade and elasticity score after NAC treatment(P<0.05); in terms of quantitative parameters, RI, Sr and PSV in MHR group were lower than those in nmhr group after chemotherapy(P<0.05); (2) The ROC curves of RI, SR and PSV respectively for breast cancer patients receiving intramuscular injection of testosterone anastrozole NAC were respectively drawn. The AUC curves were 0.811 (95% CI=0.666-0.956, P=0.002), 0.697 (95% CI=0.524-0.869, P=0.038), 0.734 (95% CI=0.570-0.897, P=0.011); (3) Univariate analysis of internal echo, blood flow classification, elastic score, RI, SR and PSV were the influencing factors of NAC efficacy in breast cancer patients. Multivariate Logistic regression analysis showed that RI, SR and PSV could affect the NAC efficacy of breast cancer patients(P<0.05). Conclusion: Ultrasound has a good application value in evaluating the efficacy of intradermal injection of testosterone anastrozole NAC in breast cancer patients. RI, SR and PSV can reliably evaluate the early efficacy of NAC in breast cancer, which can be considered for clinical application.