Application Value Of Serum VEGF In Neoadjuvant Chemotherapy Of Triple-Negative Breast Cancer

BackgroundBreast cancer is a common type of malignant tumor that seriously endangers the health of contemporary women.It is mainly caused by the continuous malignant transformation and development of normal mammary epithelial cells.Its strong aggressiveness and metastatic ability is one of the important reasons that lead to cancer and even death of contemporary women.Usually,breast cancer is divided into four subtypes according to the molecular classification of breast cancer histropathology,which are luminal type A(LuminalA type),luminal type B(LuminalB type),Human epidermal growth factor receptor-2(Her-2),Triple negative breast cancer(TNBC)and overexpression of Her-2.Among them,TNBC accounts for 10%to 15%of all invasive breast cancers and is the most aggressive among various types of breast cancers,which is prone to recurrence and metastasis and has a relatively poor prognosis.TNBC lacks the expression of hormone receptor and Her-2,and is insensitive to endocrine therapy and targeted therapy,so chemotherapy has become its mainly treatment.With the continuous development of chemotherapeutic therapy in breast cancer,Neoadjuvant chemotherapy(NAC)has also become an important component of breast cancer treatment.Various clinical trials have verified that TNBC is highly sensitive to NAC and is widely used in clinical practice.In the course of NAC,lesions can be evaluated through imaging,which directly reflects the efficacy of chemotherapy regiments.How to assist imaging examination to evaluate the efficacy and prognosis of NAC through some simple and easily accessible indexes at the early stage and during the treatment process is particularly important for the formulation of treatment plan.As a large number of tumor markers have been discovered,they can be divided into serum/plasma tumor markers and tissue and cell tumor markers.Among them,tumor markers in serum/plasma are easier to be obtained in a non-invasive way and can be monitored at different time points,which is more convenient for clinical application.Tumor biological behavior and related closely related to the formation of blood vessels,1971 Judah Folkman first proposed theory about the relationship between angiogenesis and tumor growth,the role of VEGF is known the strongest angiogenesis factors,the continuous deepening of VEGF in exploring,the serum levels of VEGF in breast cancer research also has a bigger breakthrough,is closely related to the development of breast cancer.Because TNBC has a high degree of malignancy,lacks therapeutic targets and has a good effect on NAC,this study is to explore the clinical significance and application value of monitoring serum VEGF concentration in neoadjuvant chemotherapy for triple-negative breast cancer.ObjectiveTo investigate the clinical value of monitoring serum VEGF concentration in neoadjuvant chemotherapy for triple-negative breast cancer and its effect on prognosis.MethodsThe clinicopathological data of 85 patients diagnosed with triple-negative breast cancer and receiving.neoadjuvant chemotherapy in the First Affiliated Hospital of Zhengzhou University from December 2017 to June 2019 were collected.The serum VEGF concentration was detected before NAC treatment and after two cycles of NAC treatment,and the two concentrations were compared,and they were divided into the decreased VEGF group and the increased VEGF group.NAC was divided into pCR group and non-pCR group as the criterion of efficacy.Independent sample t test was used to compare between groups,and the statistical significance between the initial serum VEGF concentration and the clinicopathological characteristics was calculated.Chi-square test or Fisher’s exact probability method was used to test the relationship between clinicopathological features and pathological responses,and the ROC curve was drawn.Univariate and multivariate survival analysis of disease-free survival in the non-pCR group was performed by Cox proportional risk regression model.The disease-free survival curve was calculated by Kaplan-Meier method.SPSS26.0 statistical software was used to analyze the data,and P<0.05 was considered statistically significant.Results1.The serum VEGF concentration and whether the patients with TNBC axillary lymph node metastasis,clinical stage and after NAC if pCR was statistically difference(P<0.05),pCR in patients with serum VEGF concentration significantly lower than patients with non-pCR,axillary lymph node metastasis and clinical stage III patients serum VEGF concentration is higher;There were no significant differences between TNBC patients’ age,postmenopausal status,primary tumor size and Ki67 expression level and serum VEGF concentration(P>0.05).2.There were statistically significant differences between the size of primary tumor,axillary lymph node status,Ki67 expression and VEGF concentration and pathological reaction(P<0.05).There was no significant difference in age,menopausal status and clinical stage(P>0.05).3.Changes in serum VEGF concentration have significant significance in evaluating the efficacy of NAC,which is more valuable than axillary lymph node metastasis,Ki67 expression level,and primary tumor size.The change of serum VEGF concentration had a negative effect on pCR,that is,patients in the elevated VEGF group had a lower probability of achieving pCR after NAC.4.Clinical stage,Ki67 expression level and changes in serum VEGF concentration were all risk factors for non-pCR patients.Clinical stage and changes in serum VEGF concentration were independent prognostic factors for decreased disease-free survival.5.The estimated median survival time of serum VEGF increased group was 14.25 months,which was significantly lower than that of serum VEGF decreased group(21.83 months),the difference was statistically significant(Log Rank P<0.05).ConclusionMonitoring the change of serum VEGF concentration in three negative neoadjuvant chemotherapy of breast cancer has certain clinical value,can the selection of treatment process of treatment for the reference index,can also assist in the early breast cancer imaging examination of disease by the method of noninvasive comprehensive assessment,and is expected to become the breast cancer biomarkers of early diagnosis and prognosis.