Prognostic value of DCE-MRI in breast cancer patients undergoing neoadjuvant chemotherapy: a comparison with traditional survival indicators

• Published in: European radiology 2015-04, Vol.25 (4), p.1097-1106
• Main Authors: Pickles, Martin D., Lowry, Martin, Manton, David J., Turnbull, Lindsay W.
• Format: Article
• Language: English
• Subjects: Adult; Age Factors; Breast - pathology; Breast cancer; Breast Neoplasms - diagnosis; Breast Neoplasms - drug therapy; Breast Neoplasms - surgery; Cancer therapies; Chemotherapy; Combined Modality Therapy; Contrast Media; Diagnostic Radiology; Disease-Free Survival; Female; Follow-Up Studies; Gadolinium DTPA; Humans; Image Enhancement; Imaging; Internal Medicine; Interventional Radiology; Magnetic Resonance; Magnetic Resonance Imaging; Medical prognosis; Medicine; Medicine & Public Health; Middle Aged; Neoadjuvant Therapy; Neuroradiology; Prognosis; Proportional Hazards Models; Radiation therapy; Radiology; Retrospective Studies; Surgery; Survival analysis; Treatment Outcome; Tumor Burden; Ultrasound
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-014-3502-5

Objectives To determine associations between dynamic contrast-enhanced MR imaging (DCE-MRI) parameters and survival intervals in patients with locally advanced breast cancer treated with neoadjuvant chemotherapy (NAC), surgery, and adjuvant therapies. Further, to compare the prognostic value of DCE-MRI parameters against traditional survival indicators. Methods DCE-MRI and MR tumour volume measures were obtained prior to treatment and post 2nd NAC cycle. To demonstrate which parameters were associated with survival, Cox’s proportional hazards models (CPHM) were employed. To avoid over-parameterisation, only those MR parameters with at least a borderline significant result were entered into the final CPHM. Results When considering disease-free survival positive axillary nodal status (hazard ratio [HR] 6.79), younger age (HR 3.37), negative oestrogen receptor status (HR 3.24), pre-treatment Maximum Enhancement Index (MaxEI) (HR 6.51), and percentage change in MaxEI (HR 1.02) represented the retained CPHM covariates. Similarly, positive axillary nodal status (HR 11.47), negative progesterone receptor status (HR 4.37) and percentage change in AUC 90 (HR 1.01) represented the retained predictive variables for overall survival. Conclusions Multivariate survival analysis has demonstrated that DCE-MRI parameters obtained prior to NAC and/or post 2nd cycle can provide independent prognostic information that can complement traditional prognostic indicators available prior to treatment. Key points • MR-derived DCE-MRI parameters obtained prior to treatment have prognostic value. • Early treatment-induced reductions in DCE-MRI parameters represents a positive prognostic indicator. • DCE-MRI parameters provide independent prognostic information that can complement traditional prognostic indicators.