The Efficacy Evaluation Of AT Regimen For NAC Breast Cancer And Analysis Of Some Concerned Protein Expression

Purpose:1. In order to discuss the therapeutic effect of different molecular subtypes of breast cancer patients after neo-adjuvant chemotherapy with AT regimen.2. In order to observe the changes of ER, PR, HER-2, CXCR4 and Ki67 expression after neo-adjuvant chemotherapy with AT regimen. Methods:A total of 79 cases of patients with breast cancer who received treatments in affiliated hospital of University of South China from January 1, 2011 to December 31, 2012 were selected as objects. They were given neo-adjuvant AT chemotherapy(doxorubicin plus paclitaxel), and ER, PR, HER- 2, CXCR4 and Ki67 were detected by the immune histochemical method. And then, the pathological morphological evaluation to the curative effect of neo-adjuvant chemotherapy was done on the basis of the expression differences of histopathology index and the use of Color Doppler Ultrasound. The relation between the clinical characteristics of patients and the chemotherapy was analyzed. This study investigated expression differences for ER, PR, HER-2, the expression of CXCR4 and Ki67 and the curative effect of neo-adjuvant chemotherapy, and then analyzed predictive effect of the five biomarkers on neo-adjuvant chemotherapy with the Logistic regression analysis method. According to different biomarkers, patients were divided into Type Luminal A, Type Luminal B, Type HER-2 expression and Type Three-negative, and clinical efficacies of patients were compared. Meanwhile, patients were followed to observe the Progression-free Survival and Overall survival. Results:1. The relationship between differences of clinical pathological characteristics and curative effect of neo-adjuvant chemotherapyThere was no significant difference in patients’ age, menopausal status, and the differences of clinical stages and curative effect of neo-adjuvant chemotherapy(P > 0.05). And as for the clinical curative effect, that for tumor with sizes of T1 ~ 2 is better than that of T3 ~ 4. As for condition of lymph node, the clinical efficacies among N0, N1, N2 and N3 showed significant difference(P < 0.05);2. The biomarkers expression differences and their curative effectsa. Before the chemotherapy, the number of ER positive expression was 61 cases accounting for 77.22%, and after 65 cases accounting for 82.28%. Before the chemotherapy, the number of PR positive expression was 50 cases accounting for 63.29%, and after 47 cases accounting for 59.49%. After the chemotherapy, the rate of HER-2 positive expression reduced to 31.65% from 37.97%, that of high CXCR4 expression reduced to 72.15% from 56.96%, and that of Ki67 positive expression reduced to 56.96% with 45 cases from 73.42% with 58 cases. Before and after neo-adjuvant chemotherapy, expression differences of ER, PR, and HER-2 showed no statistical significance(P > 0.05), and of CXCR4 and Ki67 statistical significance(P < 0.05). b. After receiving neo-adjuvant chemotherapy, as for the curative effect and pCR, those on patients with ER and PR negative expression were better than those on positive patients, and those on patients with HER-2 positive expression were better than those on negative patients. The differences of them were not statistically significant(P > 0.05). Curative effect and pCR in patients with lower CXCR4 expression were higher than those on patients with higher expression, and chemotherapy curative effects on patients with Ki67 positive expression were better than on patients with negative expression, and differences of them had significance(P < 0.05). c. About histopathologic grading curative effect evaluation, the number of patients with ER, PR and CXCR4 negative expression for MP grade from 3 to 5 was more than those with positive expression, and the result of comparison showed significant difference(P < 0.05); the number of patients with HER-2 positive expression for MP grade from 3 to 5 was more than those with negative expression, and the difference is not obvious; the number of patients with Ki67 positive expression for MP grade from 3 to 5 was more than those with negative expression, and the result of comparison showed significant difference(P < 0.05). d. The Logistic regression analysis of five biomarkers showed that CXCR4 was the independent variable of predictions of CR+PR, pCR.3. The differences in neo-adjuvant chemotherapies of different molecular subtypesAccording to expression differences of biomarkers, 79 patients with breast cancer in this study were divided into Group Luminal A with 28 cases(35.44%), Group Luminal B with 22 cases(27.85%), Group HER-2 expression with 13 cases(16.46%), and Group three-negative with 16 cases(20.25%). Clinical curative effects of neo-adjuvant chemotherapy on patients of the latter three showed no obvious difference(P>0.05), and the effects on the latter three were better than on patients of Group Luminal A(P < 0.05). The number of pCR among four groups showed no significant difference which was not statistically significant(P > 0.05). There were 5 cases of patients(17.86%) for MP grade from 3 to 5 on Group Luminal A, and 3 cases(13.64%) on Group Luminal B. The result of comparison between them showed no difference(P > 0.05). And so does the comparison between Group HER-2 expression and Group three-negative. However, the number on the latter two groups was more than that on the former two, and result of the comparison showed an obvious difference.4. The prognosis of different molecular subtypesThe use of Kaplan Meier method indicated that the comparison between DFS and OS in different patients showed a clear difference(Log- Rank: P = 0.011,P = 0.022). And results showed that patients of Group Luminal A met the best prognosis, those of Group Luminal B and Group HER-2 expression second, and Group three-negative worst. Conclusion:1.Using AT program to treat breast cancer patients at clinical II and III stage can regulate their expression of CXCR4 and Ki67.And the expression level of CXCR4 was negatively correlated with the curative effect of chemotherapy.2. AT neo-adjuvant chemotherapy regimen for different types of breast cancer patients have a different effect, triple-negative breast cancer clinical symptoms and pathological grade are better than Luminal A type, and possibly the same effect with the Luminal B type and HER-2 over expressions’ patients have, But as breast cancer with the worst prognosis molecule type, AT program can not improve Progression-free Survival and overall survival as other types of molecules are.