The Clinical Related Factors And Prognosis Of Pregnancy Associated Breast Cancer

Background:In the ranking of the incidence of malignant tumor diseases in women worldwide,the incidence of breast cancer ranks first,while the incidence of malignant tumor diseases in women during pregnancy and lactation(Pregnancy Associated Breast Cancer,PABC)is only Next to pregnancy with cervical cancer,it ranks second in pregnancy with cancer.According to the latest statistics from the International Agency for Research on Cancer of the World Health Organization,there will be approximately 19.29 million new cancer cases and 9.96 million cancer deaths worldwide in 2020.Among them,the incidence of breast cancer has surpassed that of lung cancer,becoming the world’s largest cancer,about 11.7%.PABC is a special type of breast cancer.It refers to the primary breast cancer diagnosed during pregnancy and 1 year after delivery.It has the characteristics of insidious onset,rapid disease progression,high degree of malignancy,and relatively poor prognosis.It is easy to be missed clinically.,And then develop into advanced breast cancer,and fetal factors are involved in the diagnosis and treatment process,and the treatment process is relatively complicated.In pregnant and lactating women,the mammary glands are susceptible to changes in the body’s hormone levels,resulting in a series of physiological changes.For example,the appearance of the breasts increases and the glands become denser.Therefore,the diagnosis difficulty of clinical palpation and auxiliary examination increases,and it is easy to cause delay in diagnosis.The comprehensive treatment of PABC from early diagnosis to post-diagnosis is a huge challenge currently faced by clinicians.Our goal is to extend maternal survival while ensuring the safety of the fetus.Objective:This study mainly explored the differences in clinicopathological characteristics and survival rates between PABC patients and non-pregnant breastfeeding breast cancer(Non-Pregnancy Associated Breast Cancer,Non-PABC)patients admitted to the hospital at the same time,as well as related factors that affect the prognosis of PABC patients,and improve the early stage of PABC.The diagnosis rate improves the prognosis of PABC patients.Method:The clinical data of 33 PABC patients and 116 Non-PABC patients of the same age who were admitted to the Department of Breast Surgery of the Third Affiliated Hospital of Zhengzhou University from January 1,2016 to December 31,2019 were retrospectively analyzed to explore the two groups of patients The clinical characteristics,diagnosis and treatment characteristics,and pathological characteristics of PABC,and further analysis of clinical related factors affecting the prognosis of PABC patients.Follow-up was performed to obtain disease-free survival(DFS)and overall survival(OS)of patients in the PABC group.Result:1.Differences in clinical characteristics between PABC patients and Non-PABC patientsIn this study,the clinical manifestations of PABC patients were mostly painless masses with nipple discharge,accounting for about 78.8%;the clinical manifestations of patients in the Non-PABC group were mostly painless masses,and the difference was statistically significant(P<0.05).The age of onset of patients in the PABC group was mostly patients under 35 years of age;the age of onset of patients in the Non-PABC group was mostly patients over 35 years of age;the difference in age distribution between the two groups was statistically significant(P<0.05),the age of onset of PABC Tend to be younger.Compared with the Non-PABC group,the percentage of patients with abortions ≥ 2 times in the Non-PABC group was greater than that of the PABC group,and the difference was statistically significant(P<0.05).There was no significant difference in tumor size and clinical stage between the two groups of patients(P>0.05).2.Differences in pathological characteristics between PABC patients and Non-PABC patientsThere were 25 cases with positive axillary lymph nodes in the PABC group,accounting for about 75.8%,and 57 cases with positive axillary lymph nodes in the Non-PABC group,accounting for about 49.1%;the difference in lymph node metastasis rate between the PABC group and the Non-PABC group was statistically significant(P<0.05).The negative expression rate of progesterone receptor(PR)in the PABC group was higher than that in the Non-PABC group,and the difference was statistically significant(P<0.05).The histological grade,estrogen receptor(ER),human epidermal growth factor receptor(Epidermal growth factor receptor-2,Her-2),and cell proliferation index(Ki-67)expression of the two groups of patients The difference was not statistically significant(P>0.05).Compared with patients in the Non-PABC group,Luminal B accounted for 48.5% and Luminal A accounted for 15.2% in the PABC group;Luminal B accounted for 26.7% in Non-PABC patients,and Luminal A accounted for 47.4% of patients in the two groups.The statistical results of Luminal A and Luminal B showed(P<0.05)that the difference between the two molecular subtypes was statistically significant.3.Analysis results of factors affecting the prognosis of PABC patientsRegression analysis of Cox univariate proportional hazard model showed that the first symptoms,tumor size,ER expression,whether endocrine therapy was performed are related to DFS in PABC patients;ER expression,Her-2 expression,whether endocrine therapy was performed or not,Luminal B type was related to OS in PABC patients.Regression analysis of the meaningful results of the single factor in the Cox multivariate proportional hazard model showed that the first symptom was a painless mass with nipple discharge,tumor size ≥ 2 cm,and no endocrine therapy was a high risk factor for DFS in PABC patients;Her-2 Positive is a high risk factor for OS in PABC patients.Couclusion:5.1 Compared with Non-PABC patients,PABC patients tend to have youn ger age of onset,a higher rate of lymph node metastasis,and a higher proport ion of Luminal B type.5.2 The first symptom is painless mass with nipple discharge,tumor size ≥ 2cm,and PABC patients without endocrine therapy are prone to recurrence and metastasis;Her-2 positive PABC patients have relatively poor long-term qu ality of life.