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

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

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 AUC90 (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.

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Acknowledgments

The scientific guarantor of this publication is Dr. Martin Pickles. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. This study has received funding via the Yorkshire Cancer Research CMRI endowment. Victoria Allgar, BSc (hons) PhD CStat CSci, Senior Lecturer in Medical Statistics, Department of Health, Hull York Medical School, the University of York, kindly provided statistical advice for this manuscript. Institutional review board approval was not required because approval had previously been granted for the retrospective use of such data by the Research and Development Department of Hull & East Yorkshire Hospitals NHS Trust. Written informed consent was not required for this study because approval had previously been granted for the retrospective use of such data. Since this study did not involve any non-clinical research scans or the retrieval of non-clinical patient information, informed consent was not required. Some study subjects or cohorts have been previously reported in Eur J Radiol. 2009;71:498–505. However, not only has that original cohort been expanded from 54 to 86 subjects, but the follow-up interval is longer. Further, the prognostic value of the percentage change in MR parameters between pre-treatment and post-2nd neoadjuvant chemotherapy cycle is also considered in the current manuscript. Consequently, we believe the current work differs substantially from the earlier publication. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.

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Authors and Affiliations

  1. Centre for Magnetic Resonance Investigations, Hull York Medical School at University of Hull, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ, UK

    Martin D. Pickles, Martin Lowry & Lindsay W. Turnbull

  2. Radiation Physics Department, Hull & East Yorkshire Hospitals NHS Trust, Hull, HU16 5JQ, UK

    David J. Manton

Authors
  1. Martin D. Pickles
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  2. Martin Lowry
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  3. David J. Manton
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  4. Lindsay W. Turnbull
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Correspondence to Martin D. Pickles.

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Pickles, M.D., Lowry, M., Manton, D.J. et al. Prognostic value of DCE-MRI in breast cancer patients undergoing neoadjuvant chemotherapy: a comparison with traditional survival indicators. Eur Radiol 25, 1097–1106 (2015). https://doi.org/10.1007/s00330-014-3502-5

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  • DOI: https://doi.org/10.1007/s00330-014-3502-5

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