医学影像学杂志

目的 探讨超声剪切波弹性成像(SWE)定量参数、外泌体膜联蛋白A6(ANXA6)表达在不同分子亚型乳腺癌患者中的差异及其对预后的预测价值。方法 选取240例乳腺癌患者，根据免疫组化染色结果分为Luminal A型90例、Luminal B型76例、HER-2过表达型33例、三阴性型41例。患者入院后均接受SWE检查，并检测乳腺癌组织ANXA6mRNA相对表达量，比较不同分子亚型乳腺癌患者SWE定量参数、ANXA6 mRNA表达；对患者进行随访，根据预后情况分为预后良好和预后不良，比较不同预后患者的临床病理资料、SWE定量参数及肿瘤组织ANXA6 mRNA表达，采用Logistic回归方程分析乳腺癌患者预后的影响因素，采用ROC曲线分析SWE定量参数、ANXA6 mRNA表达对乳腺癌患者预后的预测价值。结果 与HER-2过表达型、Luminal B型、Luminal A型相比，三阴性型E_max、E_mean、E_min较高，ANXA6 mRNA表达较低(P均<0.05)。截至随访结束，乳腺癌患者总生存率为74.35%，其中三阴性型总生存率为48.78%。不同预后患者肿瘤分期、淋巴结转移、E_max、E_mean、E_min及ANXA6 mRNA表达比较，差异均有统计学意义(P均<0.05)。Logistic回归分析显示，校正肿瘤分期、淋巴结转移后，ANXA6 mRNA表达、E_max、E_mean、E_min仍是乳腺癌患者预后的影响因素(P均<0.05)。ROC曲线分析显示，E_max、E_mean、E_min、ANXA6 mRNA表达联合预测乳腺癌患者预后的AUC为0.872(95%CI:0.734～0.947)，高于单一预测(P均<0.05)。结论 SWE定量参数及ANXA6 mRNA表达在三阴性型乳腺癌患者呈现异常，且均是乳腺癌预后不良的影响因素，联合检测对预后不良具有一定预测价值，可为临床判断病理类型及预测预后提供参考。

Objective To investigate the characteristics of shear wave elastography(SWE) and the difference of exosomal annexin A6(ANXA6) mRNA expression in patients with breast cancer and its clinical value in predicting prognosis. Methods A total of 240 patients with breast cancer were selected. According to the results of immunohistochemical staining, they were assigned into 90 cases of Luminal A type, 76 cases of Luminal B type, 33 cases of HER-2 overexpression type and 41 cases of TNBC type. All patients received SWE examination after admission, and the relative expression of ANXA6 mRNA in breast cancer tissues was detected. The patients were followed up regularly, according to the prognosis, they were divided into patients with good prognosis and poor prognosis. The quantitative parameters of SWE and the expression of ANXA6 mRNA in patients with different molecular subtypes of breast cancer were compared. By the end of follow-up, the prognosis and survival of breast cancer patients were counted. The clinicopathological data, SWE quantitative parameters and ANXA6 mRNA expression in tumor tissues of patients with different prognosis were compared. Logistic regression equation was used to analyze the influencing factors of breast cancer patients. ROC was used to analyze the prognostic value of SWE quantitative parameters and ANXA6 mRNA in breast cancer patients. Results Compared with HER-2 overexpression type, Luminal B type and Luminal A type, E_max, E_mean, and E_min of TNBC type were higher, and ANXA6 mRNA was lower(P<0.05). By the end of follow-up, the overall survival rate of breast cancer patients was 74.35%, and the overall survival rate of TNBC was 48.78%. There were significant differences in tumor stage, lymph node metastasis, E_max, E_mean, E_min and ANXA6 mRNA expression in patients with different prognosis(all P<0.05). Logistic regression analysis showed that ANXA6 mRNA, E_max, E_mean, and E_min were still the prognostic factors of breast cancer patients after adjusting for tumor stage and lymph node metastasis(all P<0.05). The ROC curve showed that the area under the curve(AUC) of E_max, E_mean, E_min and ANXA6 mRNA in predicting the prognosis of breast cancer patients was 0.872(95% CI: 0.734-0.947), which was higher than that of single prediction(P<0.05). Conclusion The quantitative parameters of SWE and ANXA6 mRNA are abnormal in patients with TNBC breast cancer, both of which are the influencing factors of poor prognosis of breast cancer. The combined detection has certain predictive value for poor prognosis, which can be used as an auxiliary scheme for clinical judgment of pathological types and prediction of prognosis, which can guide clinical work.