Analysis Of Prognostic Factors Of Breast-conserving Patients After Neoadjuvant Chemotherapy

Objective Based on the current research status of neoadjuvant chemotherapy(NAC)and breast-conserving therapy(BCT)for breast cancer at home and abroad,this topic analyzed the correlation between the clinicopathological characteristics and the prognosis of patients undergoing BCT after NAC had fallen,provided a theoretical basis for the standardized application of BCT after NAC,further defined the indications and contraindications of this treatment scheme,and looked for simple and effective predictors of NAC efficacy.Methods In this study,81 patients with breast cancer who underwent BCT after NAC phase down from 2010 to 2016 were retrospectively analyzed by using the multi center breast cancer database.All patients were diagnosed as breast cancer by hollow needle puncture.NAC was performed before BCT.The age,menstrual status,family history of breast cancer,BMI index,primary tumor size,axillary lymph nodes,immunohistochemistry,postoperative adjuvant chemotherapy,neoadjuvant chemotherapy efficacy,pathological complete remission,recurrence and metastasis after treatment and survival were collected and recorded.The main factors affecting the prognosis and curative effect of NAC were comprehensively analyzed by statistical methods.Results A total of 81 patients with breast cancer who met the inclusion criteria were included in this study.The subjects were all women.During the follow-up period,6 patients died because of recurrence and metastasis of breast cancer.15 patients had recurrence or metastasis,and a total of 9 cases had local recurrence.There were 6 cases of distant metastasis,including 2 cases of lung metastasis,1 case of bone metastasis,2 cases of liver metastasis combined with bone metastasis and 1 case of brain metastasis.Univariate analysis showed that the primary tumor size(P=0.003),Ki-67 expression(P=0.025)and family history of breast cancer(P=0.001)affected the disease-free survival(DFS).Primary tumor size(P=0.001),postoperative adjuvant radiotherapy(P=0.009)and Ki-67 expression(P=0.039)were important factors affecting the overall survival(OS)of patients.Estrogen receptor(ER),progesterone receptor(PR)and molecular typing were significantly correlated with pathological complete response(pCR)(P<0.05).Breast ultrasound(P=0.035)and breast MRI(P=0.008)were significantly correlated with pathological evaluation after NAC,but the consistency between imaging evaluation(ultrasound:P=0.013,Kappa:0.247;MRI:P=0.002,Kappa:0.382)and pathological evaluation was poor(Kappa<0.4).Conclusion First,the primary tumor size,Ki-67 expression and family history of breast cancer are important factors affecting the disease-free survival time of patients after operation.The larger the primary tumor,the higher the expression of Ki-67,and the family history of breast cancer can increase the risk of recurrence and metastasis.Second,the size of primary tumor,whether adjuvant radiotherapy after operation and the expression of Ki-67 affect the overall survival time of patients.The larger the primary tumor is,the patients do not receive adjuvant radiotherapy after operation,and the higher the expression of Ki-67,the worse the prognosis of patients.Third,the molecular typing of ER,PR and breast cancer is significantly correlated with pCR.The pCR rate of ER and PR negative patients is higher than that of positive patients.The pCR rate of HER-2 overexpression and triple negative breast cancer patients is higher than that of luminal breast cancer patients.Fourth,there is a significant correlation between breast ultrasound and breast MRI and pathological evaluation,but the consistency between imaging evaluation and pathological evaluation is not good.Compared with breast ultrasound,the consistency between breast MRI and pathological evaluation is higher.