Baseline MRI Features For Predicting PCR And Recurrence-free Survival Of Breast Cancer After Neoadjuvant Therapy

Objectives:Utilizing baseline MRI features for predicting pathologic complete response(PCR)and recurrence-free survival(RFS)with invasive ductal carcinoma of breast cancer after neoadjuvant chemotherapy(NAC).To explore the correlation between PCR and RFS after neoadjuvant chemotherapy,and to probe more MRI image informations.Methods:According to the inclusion and exclusion criteria,185 patients with primary invasive ductal carcinoma of breast confirmed by biopsy or surgical pathology between December 2013 and April 2017 were retrospectively collected for analysis.The clinical,pathological and MRI data of the patients were collected,and the survival was followed up.The long diameter,shape,edge,enhancement mode,ADC value,time-signal intensity curve,BPE,high signal in T2 tumor and peritumoral edema were recorded by BI-RADS-MRI terms.The patients were divided into PCR and non-PCR groups,recurrence and non-recurrence groups.The clinical,pathological and MRI imaging features were analyzed by single factor analysis first,and then the features of P<0.2 were further analyzed by multi factor analysis.Using single factor analysis tofind PCR correlation factors,t test or rank sum test were used for measurement data,while x 2 test or Fisher exact probability method were used for counting data.Kaplan Meier method was used to analyze the recurrence risk factors.Multivariate logistic regression analysis was used to analyze whether there were characteristics between PCR and n-PCR groups,and Cox proportional risk regression was used to analyze the recurrence related factors.Results:Single factor analysis showed that ER expression(P=0.047),long diameter(P=0.000)and ADC value(P=0.04)were statistically significant difference between PCR and n-PCR.Lymph node metastasis(P=0.005),size(P=0.027)and peritumoral edema(P=0.049)were statistically significant difference between recurrence and non recurrence groups.The recurrence free survival rate of patients with PCR was higher than n-PCR patiens',the difference was statistically significant(P=0.03).After multivariate logistic regression analysis,the edge of the lesion and size were independent predictors of PCR.The spicular(OR=0.274,95%CI=0.094?0.802,P=0.018)and the longer diameter(OR1=0.090,95%CI=0.026?0.315,P=0.000;OR2=0.039,95%CI=0.008?0.185,P=0.000)were along with the lower PCR rate.Cox proportional risk regression analysis showed that peritumoral edema(OR=3.483,95%CI=1.506?8.059 P=0.004),menarche age(OR=1.343,95%CI=1.073?1.683,P=0.010),lymph node metastasis(OR=2.554,95%CI=1.234?5.285,P=0.012),menopausal state(OR=0.291,95%CI=0.119?0.714,P=0.007)were independent risk factors for recurrence.The recurrence free survival rate was low when peritumoral edema appeared,the age of menarche was older,and lymph node metastasis occurred.Menopause was the protective factor of recurrence.Conclusions:The edge without spicular and smaller volume on the baseline MRI were easier obtaining PCR after neoadjuvant chemotherapy.PCR is associated with a higher recurrence free survival rate,but it is not an independent predictor.So the breast surgeons need to integrate other clinical,pathological and MRI features to analyze.Patients with the older menarche,lymph node metastases,and peritumoral edema at baseline MRI are associated with lower recurrence-free survival rate,while patients with menopause at onset have higher recurrence-free survival rate.Baseline MRI features are potential means to predict PCR and recurrence-free survival rate.