| Objective To explore the clinicopathological factors affecting the prognosis of early triple negative breast cancer(TNBC),and establish an effective prognosis prediction model,so as to make a more accurate prognosis prediction;To investigate the influencing factors and prognostic factors of neoadjuvant chemotherapy(NAC)for TNBC;To study the expression of HO-1 in TNBC tissues and analyze its correlation with the efficacy and prognosis of NAC for TNBC.Methods 1.Clinical pathological features,recurrence and metastasis,and survival of 410 patients with early TNBC admitted to our hospital from January 2011 to December 2020 were retrospectively analyzed.Three-quarters of the patients were randomly selected as the model group,univariate and multivariate cox regression analysis was used to screen the factors affecting disease-free survival(DFS)and overall survival(OS),and a Nomogram was drawn based on statistically significant variables to predict the prognosis.The remaining 1/4 of patients were included in the validation group to test the value of the prognostic prediction model.2.A retrospective analysis was performed on the clinicopathological features,efficacy of NAC and prognostic of 144 patients with TNBC treated in our hospital from January 2011 to December 2020.Logistic regression analysis was performed to analyze the factors affecting p CR after TNBC.Univariate and multivariate Cox regression analysis were used to screen the influencing factors of DFS and OS.3.117 cases of TNBC biopsy specimens received NAC in our hospital from January 2011 to December 2020 were collected.HO-1 expression in breast cancer specimens before chemotherapy was detected by by immunohistochemistry.The correlation between HO-1 expression and clinicopathological features of primary tumor,efficacy and prognosis of neoadjuvant chemotherapy was analyzed.Results 1.The median age of the 410 patients with TNBC was 49 years(20-76 years),and the median follow-up period was 40 months(10-130 months).During the follow-up period,89 patients had recurrence and metastasis.The 1,3 and 5-year disease-free survival rates were 88.1%,79.2% and 75.5%,respectively.A total of 63 patients died,and the 1,3 and 5-year overall survival rates were 98.2%,86.2%,and 81.2%,respectively.2.Cox regression analysis showed that menstrual status,N stage,Ki-67,e-cadherin,SII,PLR and CA125 were independent prognostic factors affecting DFS in model group.Menstrual status,N stage,e-cadherin,SII and CA125 were independent risk factors affecting OS in the model group.3.Combining the above independent prognostic factors,a Nomogram was drawn to predict DFS and OS respectively.The Concordance index(C-index)of the Nomogram model to evaluate DFS and OS is 0.795(95%CI:0.768 ～ 0.824)and 0.813(95%CI:0.771 ～ 0.865),respectively.The AUC of 3-year DFS and 5-year DFS predicted by ROC curve was 0.792 and 0.805,respectively.The AUC of 3-and 5-year OS was 0.815 and 0.825,respectively,the AUC of DFS and OS predicted by TNM staging are significantly lower than those predicted by Nomogram model.4.A total of 144 patients with TNBC who received NAC were enrolled,with a median age of 48 years(23-67 years).After NAC,57 patients(39.6%)received CR,72 patients(50.0%)received PR,13 patients(9.0%)received SD,and 2 patients(1.4%)received PD.p CR was obtained in 46 cases(31.9%).5.Logistic regression analysis showed that T stage,N stage,vascular tumor thrombus,NAC cycle and SII were independent factors to predict p CR.6.Cox regression analysis showed that E-cadherin,CA125,CA199,lymph node status after NAC,pathological MP grade and p CR were independent prognostic factors affecting DFS.E-cadherin,CA125 and lymph node status after NAC were independent prognostic factors affecting OS.For non-p CR patients,CA125,lymph node status after NAC and capecitabine intensive treatment were independent prognostic factors affecting DFS.Menstrual status,CA125 and lymph node status after NAC were independent prognostic factors affecting OS.7.Among 117 patients with TNBC,69.2%(81/117)had high HO-1 expression and 30.8%(36/117)had low HO-1 expression.HO-1 expression was significantly correlated with histological grade(P=0.022),lymph node status(P=0.005)and Ki-67 expression(P=0.015).The p CR rate of patients with low HO-1 expression was 50.0%(18/36),while that of patients with high HO-1 expression was 29.6%(24/81),the difference was statistically significant(P=0.034).8.Kaplan-meier survival curve showed that there were statistically significant differences in DFS(P=0.006)and OS(P=0.012)between the HO-1 high expression group and the HO-1 low expression group.Patients with low HO-1 expression had significantly better DFS and OS than those with high HO-1 expression.Cox regression analysis showed that HO-1 was an independent prognostic factor for DFS and OS.Conclusions 1.Menstrual status,N stage,Ki-67,E-cadherin,SII,PLR and CA125 were independent prognostic factors affecting DFS in patients with early TNBC,while menstrual status,N stage,E-cadherin,SII and CA125 were independent prognostic factors affecting OS.2.The DFS prediction model based on menstruation,N stage,Ki-67,E-cadherin,SII,PLR and CA125 and OS prediction model based on menstrual status,N stage,E-cadherin,SII and CA125 have good differentiation and accuracy in prognosis prediction of early TNBC,and have good clinical application value.3.Tumor size,axillary lymph node status,presence or absence of vascular cancer plug,neoadjuvant chemotherapy cycle and SII were independent factors affecting the efficacy of NAC for TNBC.4.E-cadherin,CA125,CA199,lymph node status after NAC,pathological MP grade and p CR were independent factors affecting the DFS of TNBC after NAC,while E-cadherin,CA125 and lymph node status after NAC were independent influencing factors of OS.5.In TNBC patients with high HO-1 expression,the p CR rate of NAC was lower and the prognosis was worse.HO-1 may be used as a new indicator for clinical efficacy prediction and prognosis evaluation of NAC for TNBC. |
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