| Objective: This study analyzed the effects of clinical case characteristics of breast cancer patients on p CR after neoadjuvant chemotherapy,and observed the different pathological remission states of primary tumors and lymph nodes after chemotherapy,combined with the clinical and pathological characteristics of the patients to analyze its impact on the prognosis.Hope to provide more treatment experience for precise neoadjuvant chemotherapy for breast cancer.Methods: For case collection,the primary breast cancer patients who were admitted to the Department of Breast Surgery,Affiliated Tumor Hospital of Guangxi Medical University from January 2013 to December 2014 were selected for retrospective analysis.These patients were treated with preoperative neoadjuvant chemotherapy.,Regularly assess the clinical efficacy,and choose the right time for surgery.After the operation,the pathological remission of the primary breast tumor and axillary lymph nodes were evaluated,and the patient’s5-year OS rate and DFS were analyzed.Results: A total of 155 patients received preoperative neoadjuvant chemotherapy from January 2013 to December 2014.Among the 155 patients,23 had complete p CR,with a p CR rate of 14.8%;only axillary lymph nodes had remission in 34 cases(21.9%),and only breast primary tumors had remission in4 cases(2.6%);94 cases were It is completely non-p CR,up to 60.6%.In the process of analyzing the influencing factors of pathological complete response(p CR),in terms of complete p CR,98 patients with Luminal type,10 patients with complete p CR,p CR rate 10.2%,57 patients with non-Luminal type,and complete p CR 13 cases,the p CR rate was 22.8%,there was a statistically significant difference between the two groups(P=0.033),tumor diameter,preoperative clinical TNM stage,pathological type,menstruation,age,skin and chest wall violations and targets Drug application,chemotherapy regimen,chemotherapy course,etc.were not found to be correlated with complete p CR.In terms of the p CR of primary breast tumors,98 patients with Luminal type,10 patients with tumor p CR,p CR rate 10.2%,57 patients with non-Luminal type,17 patients with tumor p CR,p CR rate 29.8%,the difference between the two groups was statistically significant.Meaning(P=0.002).Tumor size,pathological type,clinical stage,age,menstruation,skin and chest wall invasion,targeted drug application,chemotherapy regimen,chemotherapy course,etc.were not found to be correlated with tumor p CR.In terms of axillary lymph node p CR,tumor size,pathological type,molecular type,age,menstruation,skin and chest wall invasion,targeted drug application,chemotherapy regimen,etc.were not found to be correlated with lymph node p CR.There are 66 cases of clinical stage II patients,32 cases of lymph node p CR,and a p CR rate of 48.5%;89 cases of stage III patients,25 cases of lymph node p CR,and a p CR rate of28.1%.The difference between the two groups is statistically significant.(P=0.009).In terms of the course of preoperative chemotherapy,11 patients received 1-3 courses of chemotherapy,3 patients received lymph node p CR,and the p CR rate was 27.3%,112 patients received 4-5 courses of chemotherapy,36 patients received lymph node p CR,and the p CR rate was 32.1%.There were 32 patients with 6-8 courses of chemotherapy and 18 patients with lymph node p CR.The p CR rate was 56.3%.The difference between the groups was statistically significant(P=0.039).Based on the evaluation of postoperative pathological specimens,155 patients were divided into 5 subgroups: complete p CR,incomplete p CR,complete non-p CR,lymph node p CR only,and tumor p CR.The five groups were compared in pairs,and DFS and OS analysis showed that patients with complete p CR(5-year DFS rate 87%)were significantly higher than those with incomplete p CR(DFS rate 63.6%)(P=0.028).The 5-year OS rate of the complete p CR group was 95.7%,and the DFS rate was 87.%,the 5-year OS rate in the complete non-p CR group was 73.4%,and the DFS rate was 60.6%.Compared with the complete non-p CR group,OS and DFS were significantly higher in complete p CR(P=0.021,0.017).The 5-year OS rate in the tumor p CR group was 96.3%,DFS The rate was 85.2%,the 5-year OS rate in the non-tumor p CR group was 76.6%,the DFS rate was 64.8%,the tumor p CR was significantly higher than the non-tumor p CR group OS and DFS(P=0.020,0.039),the 5-year OS rate in the lymph node p CR group was 89.5%,The DFS rate was 82.1%,the 5-year OS rate of the non-lymph node p CR group was74.5%,and the DFS rate was 61.2%.Compared with the non-lymph node p CR group,OS and DFS were significantly improved(P=0.025,0.012).In terms of recurrence(or metastasis)mortality,the recurrence(or metastasis)mortality rate of the complete p CR group was 13.0%,the recurrence(or metastasis)mortality rate of the tumor-only p CR group was 25%,and the recurrence(or metastasis)mortality rate of the lymph node p CR group only20.6%,the recurrence(or metastasis)mortality rate of the complete non-p CR group was 40.4%,and the results of each group were statistically significantly different(P=0.031).In the univariate survival analysis of the prognosis,it was found that in terms of postoperative axillary lymph node remission,58 patients(37.4%)with lymph node p CR(N0)and 97 patients(62.6%)with lymph node no p CR were compared between the two groups at 5 years.The differences in DFS and OS were statistically significant(P=0.041,0.021).In terms of postoperative remission status of primary breast tumors,there were 27 patients(17.4%)with postoperative tumor p CR and 128 patients(82.6%)with non-p CR tumors.The two groups had statistically significant differences in DFS and OS(P= 0.049,0.024).In terms of postoperative pathological staging,23 cases were stage 0(complete p CR),17 cases were stage IA,29 were stage ⅡA,39 were stage ⅡB,39 were stage ⅢA,11 were stage ⅢB,and 11 were stage ⅢC.For example,comparing DFS and OS of each group,the difference was statistically significant(P=0.000,0.000).In terms of Ki-67 changes,29 cases had an index increase,16 cases had an index constant,and 110 cases an index had decreased.The differences in DFS and OS of each group were statistically significant(P=0.039,0.018).In the multivariate regression analysis,it was found that postoperative pathological staging was an independent factor affecting the outcome of recurrence and metastasis(P=0.004),and the higher the stage,the worse the prognosis.Conclusion: 1.Molecular classification is an independent factor that affects the p CR rate of locally advanced breast cancer after neoadjuvant chemotherapy.The non-Luminal type is easier to obtain tumor p CR and complete p CR.2.The lymph node p CR rate after neoadjuvant chemotherapy is related to the course of preoperative chemotherapy,and the established course of chemotherapy should be completed when conditions permit.3.The prognosis of breast cancer patients with complete p CR after neoadjuvant chemotherapy is better than that of incomplete p CR patients,and the prognosis of patients with lymph node p CR or tumor reaching p CR is better than that of non-p CR patients.The prognosis of breast cancer patients is related to lymph node remission status,tumor remission status,Ki-67 changes and postoperative pathological staging,and postoperative pathological staging is an independent predictor of prognosis. |
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