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| 术前钼靶X线磁共振检查及外泌体ctDNA水平与TNBC术后复发的关联研究 |
| Correlation between preoperative mammography, magnetic resonance imaging, extracellular vesicle ctDNA levels and postoperative recurrence of TNBC |
| 投稿时间：2025-10-15 |
| DOI：10.3969/j.issn.1000-0399.2026.07.011 |
| 中文关键词: 钼靶X线 磁共振 外泌体循环肿瘤DNA 三阴性乳腺癌 复发 影响因素 |
| 英文关键词: Molybdenum target X-ray Magnetic resonance imaging Extracellular vesicle circulating tumor DNA Triple negative breast cancer Recurrence Influence factor |
| 基金项目:廊坊市科学技术研究与发展计划(编号:2022013124) |
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| 中文摘要: |
| 目的 探讨术前钼靶X线、磁共振（MRI）检查及外泌体循环肿瘤DNA(ctDNA)水平与三阴性乳腺癌（TNBC）术后复发的关联。方法 采用前瞻性研究方法，选取2020年7月至2022年7月在河北中石油中心医院治疗的TNBC患者126例为研究对象，随访3年。按照是否复发，分为复发组（n=43）和未复发组（n=83）。比较两组患者临床基线资料，术前钼靶X线及MRI参数、外泌体ctDNA水平差异，分析术后复发的影响因素。结果 术后复发患者TNM分期Ⅲ期比例为48.84%，未复发组为20.48%，复发组高于未复发组（P<0.05）；术后复发患者术前钼靶X线参数：无钙化、有腋窝淋巴结受累比例分别为88.37%、48.84%，未复发组分别为61.45%、26.51%;MRI参数：病灶高信号、环状强化比例分别为58.14%、48.84%，未复发组分别为26.51%、21.69%，复发组均高于未复发组（P<0.05）。术后复发患者术前外泌体ctDNA水平为（640.30±83.30）ng/mL，高于未复发组的（602.23±90.44）ng/mL(P<0.05)。logistic回归分析显示：TNM分期、钼靶X线参数钙化、钼靶X线参数腋窝淋巴结受累、MRI参数病灶高信号、MRI参数环状强化和外泌体ctDNA水平是TNBC患者术后复发的影响因素（P<0.05）。受试者工作特征（ROC）曲线分析显示，基于TNM分期、钼靶X线参数（钙化、腋窝淋巴结受累）、MRI参数（病灶高信号、环状强化）及外泌体ctDNA水平构建的联合预测模型曲线下面积为0.866(95%CI:0.799～0.932,P<0.05)，灵敏性和特异性分别为79.10%和85.50%。结论 术前钼靶X线、MRI参数及外泌体ctDNA水平变化与TNBC术后复发具有关联，临床治疗前应加以重视。 |
| 英文摘要: |
| Objective To investigate the relationship between preoperative molybdenum target X-ray and magnetic resonance(MRI), the level of tumor DNA in the exocrine circulation(ctDNA) and postoperative recurrence of triple negative breast cancer(TNBC). Methods Prospective research methods was used, 126 TNBC patients treated in Hebei PetroChina Central Hospital from July 2020 to July 2022 were selected, and follow-up lasted for three years. The patients were divided into the recurrence group(n=43) and the non-recurrence group(n=83) based on whether recurrence occurred. The differences in clinical baseline data, mammography and MRI parameters, and extracellular vesicle ctDNA levels between two groups were compared, and the influencing factors for postoperative recurrence were analyzed. Results The proportion of postoperative recurrent patients with TNM stage Ⅲ was 48.84%, which was higher than that of non recurrent patients(20.48%)(P<0.05). Preoperative mammography parameters for patients with postoperative recurrence showed that the proportion of patients without calcification and with axillary lymph node involvement was 88.37% and 48.84%, respectively.The corresponding rates in the non-recurrence group were 61.45% and 26.51%, respectively. MRI parameters showed that the proportion of high signal and circular enhancement lesions was 58.14% and 48.84%, respectively, which was higher than that of non recurrent patients(26.51% and 21.69%)(P<0.05). The preoperative level of extracellular vesicle ctDNA in patients with postoperative recurrence was(640.30 ± 83.30) ng/ml, which was higher than that in patients without recurrence(602.23±90.44)ng/mL(P<0.05). Logistic regression analysis showed that TNM staging, calcification, axillary lymph node involvement, high signal intensity of lesions, circular enhancement, and extracellular vesicle ctDNA were the influencing factors for postoperative recurrence in TNBC patients(P<0.05). The ROC curve analysis revealed an area under the curve of 0.866(95% CI: 0.799～0.932), with P< 0.05, and sensitivities and specificities of 79.10% and 85.50%, respectively. Conclusion Preoperative mammography, MRI parameters, and extracellular vesicle ctDNA levels are influencing factors for postoperative recurrence of TNBC, which should be taken seriously before clinical treatment. |
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