Evaluation Of Neoadjuvant Chemotherapy For Breast Cancer And Influencing Factors

Objective:We retrospectively analyzed the clinical and pathological characteristics of breast cancer patients who underwent neoadjuvant chemotherapy and investigate the correlation between tumor molecular type,molecular subtypes and other factors and the prognosis of patients,and observe the safety of neoadjuvant chemotherapy in clinical application,which can provide reference for the clinical application of neoadjuvant chemotherapy.Methods:Women with locally advanced breast cancer patients who underwent neoadjuvant chemotherapy from Jan 2006 to Dec 2008 in Tianjin tumor hospital were collected.We collected the demographic information and clinical and pathological information,and then observed the change of tumor primary lesions in clinical and pathological to evaluate the short-term curative effect,follow-up of patients three years and five years disease-free survival and survival status to analyze the long-term effevtion.We analyzed the effect of molecular typing,tumor characteristics and other factors on the short-term and long-term curative effect of neoadjuvant chemotherapy using univariate and multivariate analysis methods.To understand the adverse reactions of blood system,evaluate its safety in clinical application.Results:This study included 190 cases with locally advanced breast cancer patients with neoadjuvant chemotherapy in receiving anthracycline plus taxane and anthracycline based,including 76 cases of clinical stage II patients,114 cases of stage III patients;87 cases were ER positive,83 cases were PR positive,23 cases were HER-2 positive,165 cases the expression rate of Ki-67 was 15%.All patients of new adjuvant chemotherapy were clinical evaluated,38 cases with CR(20%)were found,108(57%)patients with PR were found,37 cases(19%)with SD were found,7 cases(4%)with PD were found.The proportion of patients with stage II who were effective in neoadjuvant chemotherapy was 68.42%(52/76),the proportion of stage III was(95/114),the difference was statistically significant(P < 0.05).Pathological evaluation of neoadjuvant chemotherapy in all patients,the rate of pCR was 10.53%(22/190).Univariate analysis showed that age,menstruation,abortion history,family history of cancer,the clinical pathological characteristics,cycle of neoadjuvant chemotherapy and neoadjuvant chemotherapy was not correlated(P >0.05),T stage after chemotherapy and clinical staging and clinical staging of TNM after chemotherapy and local tumor response to chemotherapy was positively correlated(P < 0.05).The pCR was different between the groups expression of Ki-67(P < 0.05);The HR positive and pCR rate was not correlated(P > 0.05);Between Luminal,over expression of Her-2 and three negative breast cancer groups,the p CR rate were not statistically significant difference(P > 0.05);The pCR of Luminal A,Luminal B,overexpression of Her-2 type and basal-like type breast cancer patients were statistically significant difference(P > 0.05).Multi factor analysis showed that the expression level of Ki-67 and the degree of response to chemotherapy were independent factors that affected the patients with pCR after neoadjuvant chemotherapy.Long term follow-up showed that the overall 5 year survival rate was 68.95%.ER positive and negative patients 3-year DFS(75.3% Vs 61.2%),the 3-year OS(88.7% Vs 77.9%),5-year DFS(68.2% Vs 51.1%)and the 5-year OS(75.4% Vs 52.8%)had significant difference(P < 0.05).There were significant differences between PR positive and negative patients in survival index(P value was 0.05).The expression of Her-2 and Ki-67 were not correlated with the prognosis of patients(P value was 0.05).HR typing,Luminal three type,Luminal type four were correlated with the prognosis of patients(P values were less than 0.05).Univariate analysis showed that neoadjuvant chemotherapy before and after chemotherapy,the tumor T stage,N stage,chemotherapy and pCR were associated with survival of patients(P < 0.05).The patient’s age,menopausal status and history of abortion were not correlated with the prognosis(P value > 0.05);according to the expression of different molecular groups,we found that the expression of ER,PR and HR type and Luminal type were correlated with total survival rate(P < 0.05).Multivariate analysis showed that pCR and pathological T staging were independent factors affecting the survival rate of breast cancer patients after neoadjuvant chemotherapy(P < 0.05).After neoadjuvant chemotherapy,there were adverse reactions of blood system in different degree.Neutropenia is the most common chemotherapy regimens.There was no differences between anthracycline plus taxane and anthracycline chemotherapy based in adverse reactions of blood system aspects(P <0.05).Conclusion:1、The clinical total effective rate of neoadjuvant chemotherapy for locally advanced breast cancer is 74.21%,and the patients with stage III were more likely to achieve the effect of neoadjuvant chemotherapy.2、The pathological short-term curative effect of neoadjuvant chemotherapy for locally advanced breast cancer was 10.53%,Ki-67 expression level and the degree of chemotherapy response were the independent factors of neoadjuvant chemotherapy.The patients whose Ki-67 was higher than 15% were more easily get pathological complete remission.The more obvious the response to chemotherapy,the more likely to get pCR.3、The overall survival rate of locally advanced breast cancer after neoadjuvant chemotherapy was 68.95%,pCR and pathological T stage were the independent prognostic factors.The prognosis of patients with pCR after neoadjuvant chemotherapy and patients with earlier pathological T stage was relatively good.The molecular classification based on the levels of estrogen,progesterone,Her-2 and Ki-67 showed the influence on the prognosis of patients only in univariate analysis.4、There were no differences in the safety of blood system between the anthracycline and taxane and anthracycline based neoadjuvant chemotherapy.