Correlation Analysis Of Hormone Receptor And Response To Neoadjuvant Chemotherapy In Breast Cancer And Construction Of A Predictive Model

Background and objective: Neoadjuvant chemotherapy(NAC)is an important method for the treatment of breast cancer.It is well known that patients who achieve pathological complete response(p CR)after NAC have significant benefits.But some patients have no response or worse still progress on NAC.Therefore,it is necessary to identify the predictors of NAC efficacy in order to distinguish patients who may benefit from NAC.Hormone receptors play an important role in comprehensive treatment of breast cancer.Whether or not the quantitative status and expression intensity of hormone receptors are related to the efficacy of NAC remains to be determined.The study aims to investigate the correlation between the different expression status of hormone receptors and the response to NAC,to explore the clinical and pathological factors affecting response to NAC,and establish a nomogram of NAC efficacy to assess the probability of benefit after NAC in breast cancer.Methods: In the retrospective study,a total of 91 patients with invasive breast cancer who underwent NAC at the Breast Surgery Department in the Third Affiliated Hospital of Guangzhou Medical University from June 2013 to June 2020 were enrolled.The patients were treated with surgery after NAC.According to the efficacy of NAC evaluated by postoperative pathology,the patients were assigned into p CR group and Non-p CR group.The univariate analysis was performed to analyze the correlation between the clinical pathological characteristics of breast cancer and the efficacy of NAC.The multivariate logistic regression analysis was performed to identify independent predictors of response,based on which a prediction model of response to NAC was constructed and visualized as a nomogram.The performance of the predictive model was evaluated by receiver operating characteristic(ROC)curve and calibration curve.Results: In the study cohort,15 patients(16.5%)achieved p CR and 3 patients(3.3%)developed disease progression.On univariate analysis,tumor size,estrogen receptor(ER)quantitative expression,ER expressive intensity,progesterone receptor(Pg R)quantitative expression,human epidermal growth factor receptor-2(HER2)status,Ki-67 index and number of chemotherapy cycles were significantly correlated with p CR(P<0.05).On multivariate analysis,tumor size,ER quantitative expression and number of chemotherapy cycles were independent predictors of p CR after NAC(P<0.05).Based on these three independent factors,the predictive model of reponse to NAC was established.The area under ROC curve of the predictive model was0.938,indicating good discrimination.The calibration curve showed the predicted and actual proportions were slightly biased,indicating poor calibration of the predictive model.Conclusion: The quantitative expression of estrogen receptor,tumor size and number of chemotherapy cycles are independent factors of p CR after NAC in breast cancer.The established prediction nomogram of response to NAC can visually and rapidly facilitate preliminary assessment of the probability of p CR from NAC in breast cancer.