| Objective: To evaluate the effect of anthracycline-based neoadjuvant chemotherapy on the response rate and overall survival of patients with triple negative breast cancer.Methods: Systematic review and meta analysis of the effect of all the prospective or retrospective cohort studies on anthracycline-based neoadjuvant chemotherapy for patients with triple negative breast cancer were performed.The following electronic database, PubMed, Ovid,CBM,VIP and CNKI, were searched, and seven kind of journals (including the Chinese Joumal of Breast cancer and the Chinese Journal of clinical Oncology ) were reviewed. The inclusion of the trials , the quality assessment and data extraction were performed by two reviewers independently. RevMan4.2.2 software developed by the Cochrane collaboration was used for Meta-analysis. Clinical response rate, pathological complete response rate,3-year disease free survival, 5-year disease free survival and 5-year overall survival were the primary study endpoints.Results: Six trials including 1950 patients with breast cancer were included in this systematic review. 476 patients were triple negative breast cancer and 1474 patients were non- triple negative breast cancer. Two studies were prospective cohort studies, the other four studies were retrospective cohort studies. Meta-analysis based on included trials showed that clinical response rate of triple negative breast cancer was higher , compared with non- triple negative breast cancer[OR 2.84,95%CI(1.78-4.52)];Pathlogic complete response rate of triple negative breast cancer was significantly higher than non-triple negative breast cancer [OR 2.78,95%CI(2.11-3.66)]; 3-year disease free survival rate of triple negative breast cancer was lower, compared with non-triple negative breast cancer [OR 0.51, 95%CI(0.39-0.68)];5-year disease free survival rate of triple negative breast cancer was lower ,compared with non-triple negative breast cancer [OR 0.47,95%CI(0.28-0.77)];5-year overall survival rate of triple negative breast cancer was lower, compared with non-triple negative breast cancer [OR 0.39,95%CI(0.30-0.51)].Descriptive analysis showed that 5-year disease free survival rate of triple negative patients and non-triple negative patients who achieved pCR were 94.1% and 92.3%,respectively(P=0.414); 5-year overall survival rate were 94.1% and 100%, respectively (P=0.617). 5-year disease free survival rate of triple negative patients and non-triple negative patients who did not achieved pCR were 30% and 83%, respectively (P<0.001); 5-year overall survival rate were 60% and 93.2%, respectively (P=0.013).Conclutions: Patients with triple negative breast cancer were more sensitive to the anthracycline-based neoadjuvant chemotherapy than those with non-triple negative breast cancer, but the long-term survival of patients with triple negative breast cancer was worse than those with non-triple negative breast cancer. Patients with triple negative breast cancer who achieved pathlogic complete response had the similar prognosis to those with non-triple negative breast cancer. Patients of triple negative breast cancer with residual disease after neoadjuvant chemotherapy had a poorer prognosis . Due to the less quantity and poor quality of included trials, more prospective clinical trials with larger-cases are necessary for evidence-based therapy.
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