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目的:探讨动态增强磁共振成像（magnetic resonance imaging，MRI）参数联合外周血全身炎症反应指数（systemic inflammatory response index，SIRI）预测三阴性乳腺癌（triple-negative breast cancer，TNBC）改良根治术后复发转移的价值。方法:对2019年1月至2021年12月于绍兴市上虞人民医院和舟山市妇幼保健院行改良根治术的351例TNBC患者进行为期2年随访，按照术后是否复发分为复发组（32例）及未复发组（319例），收集患者临床资料，分析影响患者术后复发的危险因素，记录患者术前动态增强MRI参数及外周血SIRI水平，分析二者对患者术后复发的预测价值。结果:两组临床分期、术前是否接受新辅助化疗构成比比较，差异有统计学意义（ χ 2=19.56、7.53， P均<0.05）。复发组不规则肿瘤形态占比高于未复发组（ χ 2=9.031， P均<0.05）。复发组感兴趣区转运常数K trans、反流速率常数K ep及SIRI水平均高于未复发组（ χ 2=15.26、3.89、10.10， P均<0.05），两组血浆容积分数V p、达峰时间（time to peak，TTP）比较，差异无统计学意义（ P>0.05）。多因素Logistic回归分析显示：临床分期为III期、术前未接受新辅助化疗、术前不规则肿瘤形态、高K trans值、高K ep值及高SIRI水平均为TNBC患者术后复发转移的危险因素。ROC结果显示，术前K trans、术前K ep、SIRI预测TNBC患者术后复发转移的曲线下面积（area under the curve，AUC）分别为0.797、0.737、0.741；三者联合预测TNBC患者术后复发转移的AUC为0.797，敏感度为59.4%，特异度为94.36%（均 P<0.05）。 结论:高K trans值、高K ep值及高SIRI水平均为TNBC患者术后复发转移的危险因素，三者联合预测TNBC患者术后复发转移的曲线下面积及敏感度、特异度较高。

Objective:To investigate the value of dynamic enhanced magnetic resonance imaging (MRI) parameters combined with peripheral blood systemic inflammatory response index (SIRI) in predicting recurrence and metastasis after modified radical triple-negative breast cancer (TNBC) .Methods:A total of 351 TNBC patients who received modified radical surgery in our hospital from Jan. 2019 to Dec. 2021 were followed up for 2 years, and were separated into the recurrence group ( n=32) and the non-recurrence group ( n=319) according to whether they had recurred after surgery. Clinical data of patients were collected, risk factors affecting postoperative recurrence were analyzed, preoperative dynamic enhanced MRI parameters and peripheral blood SIRI level of patients were recorded, and the predictive value of both in postoperative recurrence was analyzed. Results:There were statistically significant differences in clinical stage and preoperative neoadjuvant chemotherapy between the two groups ( χ2=19.56, 7.53, P<0.05). The proportion of irregular tumor morphology in recurrence group was higher than that in non-recurrence group ( χ2=9.031, P<0.05). The levels of transport constant K trans, reflux rate constant K ep and SIRI in the recurrence group were higher ( χ2=15.26, 3.89, 10.10, P<0.05), and there was no statistically significant difference in plasma volume fraction V p and time to peak (TTP) between the two groups ( P>0.05). Multivariate Logistic regression analysis showed that stage III, no neoadjuvant chemotherapy before surgery, irregular tumor shape before surgery, high K trans value, high K ep value and high SIRI level were all risk factors for postoperative recurrence and metastasis in TNBC patients. ROC results showed that the area under the curve (AUC) of preoperative K trans, preoperative K ep and SIRI in predicting postoperative recurrence and metastasis of TNBC patients were 0.797,0.737 and 0.741, respectively. The combined prediction of AUC for postoperative recurrence and metastasis of TNBC patients was 0.797, sensitivity was 59.4%, and specificity was 94.36% (all P<0.05) . Conclusions:High K trans value, high K ep value and high SIRI level are all risk factors for postoperative recurrence and metastasis in TNBC patients. The area under the curve, sensitivity and specificity predicted by their combination for postoperative recurrence and metastasis in patients with TNBC are relatively higher.