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目的评估首次新辅助化疗之前的乳腺肿瘤初始血红蛋白(Hb)含量,监测每一治疗周期结束后Hb的变化,并将该发现与肿瘤病理反应性进行相关性分析。材料与方法本研究符合HIPAA标准,经两个机构的审查委员会批准。获得所有病人的书面知情同意书。将2007年12月—2011年5月适合进行新辅助化疗的病人纳入本研究,采用一种连接超声系统的近红外成像仪来检测肿瘤Hb含量。32例女性(平均年龄48岁,范围32~82岁)分别在治疗前,每一治疗周期结束后及最终外科手术前进行成像。依据病人最终病理反应按照Miller-Payne系统进行分级,无反应及部分反应者(1~3级),接近完全反应及完全反应者(4、5级)。通过总血红蛋白(tHb)、氧合血红蛋白(oxyHb)及脱氧血红蛋白(deoxy-Hb)含量进行肿瘤血供评估。以治疗前血红蛋白水平为参考,通过治疗前后tHb的百分比对治疗过程中肿瘤血供变化进行评估。采用两样本双向t检验计算P值和评估两组间的统计学差异。采用Bonferroni-Holm校正获得多重比较的矫正P值。结果 20例肿瘤为Miller-Payne1~3级,14例为4或5级。4或5级肿瘤的治疗前平均最大tHb、oxyHb及deoxy-Hb水平均明显高于1~3级者(分别为P=0.005,P=0.008及P=0.017)。1~3个周期治疗后,4或5级肿瘤tHb的平均百分率改变显著高于1~3级者(P=0.009及较正P=0.009;P=0.002及较正P=0.004;P=0.001及较正P=0.001)。结论本研究结果提示肿瘤初始Hb含量是预示最终病理反应的一个显著指标。另外,tHb在早期治疗周期中的改变能够进一步预测最终病理反应。
Objective To evaluate the initial hemoglobin (Hb) level in breast tumors before the first neoadjuvant chemotherapy and to monitor the change of Hb after each treatment cycle. The correlation between the Hb level and tumor pathological reactivity was also analyzed. Materials and Methods This study is in accordance with the HIPAA standards and approved by the two bodies’ review committees. Get written informed consent from all patients. Patients eligible for neoadjuvant chemotherapy between December 2007 and May 2011 were included in this study using a near-infrared imager connected to an ultrasound system to detect tumor Hb levels. Thirty-two women (mean age, 48 years, range, 32-82 years) were imaged before treatment, after each treatment cycle, and before the final surgery. According to the patient’s final pathological response according to Miller-Payne system grading, no response and partial response (grade 1 to 3), close to the complete response and complete response (grade 4,5). Tumor blood supply was assessed by total tHb, oxyHb, and deoxy-Hb levels. Based on the pretreatment hemoglobin level, the change of blood supply to the tumor during the course of the treatment was evaluated by the percentage of tHb before and after treatment. Two-sample bi-directional t-test was used to calculate P values and to assess the statistical differences between the two groups. Correction P values for multiple comparisons were obtained using Bonferroni-Holm calibration. Results Twenty tumors were grade 1 to 3 with Miller-Payne and 4 or 5 with 14 lesions. The mean maximum tHb, oxyHb and deoxy-Hb levels were significantly higher in patients with grade 4 or 5 before treatment than those with grade 1 to 3 (P = 0.005, P = 0.008 and P = 0.017, respectively). After 1 to 3 cycles of treatment, the mean percentages of tHb in grade 4 or 5 tumors were significantly higher than those in patients with grades 1 to 3 (P = 0.009 and positive P = 0.009; P = 0.002 and positive P = 0.004; P = 0.001 And corrected P = 0.001). Conclusions The results of this study suggest that the initial Hb content of the tumor is a significant indicator of the ultimate pathological response. In addition, changes in tHb during the early treatment cycles can further predict the final pathological response.