Significance Of Neoadjuvant Chemotherapy And Molecular Marker Changes In Breast Cancer

Objective Along with the development of the treatment of breast cancer,it is particularly important to explore an individualized comprehensive treatment options that is most suitable for patients,Neoadjuvant Chemotherapy(NAC)is the new treatment of breast cancer,introduced in the 1970s,In this approach,patients are given systemic medication before surgery,but its applicable population and clinical benefit is not yet clear.This study is to explore the significance and find the best applicable population of neoadjuvant chemotherapy(NAC)in breast cancer;To investigate the effect of NAC on the expression status of molecular markers,such as estrogen receptor,progesterone receptor,human epidermal growth factor receptor 2 and Ki-67 antigen,and to study the prognostic value of such expression changes.Methods The continuous cases of breast cancer patients who underwent surgical treatment in Qilu Hospital of Shandong University from January 2009 to December 2017 were summarized and analyzed retrospectively.Clinical information was initially collected on 2928 patients,After screening by inclusion and exclusion criteria,1817 cases were included.Clinical and surgical pathological information mainly included:age,menstrual and child-bearing history,breast mass size at initial diagnosis,status of lymph nodes,laboratory examination results,pathological information before and after NAC,surgical methods,Continued treatment after surgery obtained through telephone follow-up,survival status and recurrence of patients and so on,SPSS 25.0 and EmpowerR 2.0 statistical software were used for analysis.Classification data were described by relative numbers,differences between groups were described by Pearson Chi-square test,survival(patients’ OS and DFS)was analyzed by Kaplan-Meier survival curve and log-rank test.COX regression was used to analyze the influence of clinicopathological indicators on prognosis of patients in NAC group and adjuvant chemotherapy group,including age,tumor size at initial diagnosis,lymph node status at initial diagnosis,menopause status,number of lymph node metastasis,and molecular classification.According to the influence of NAC on the expression of ER,PR,Her-2 and Ki-67,the prognostic value of the changes in molecular markers was explored.Results COX regression analysis showed that compared with adjuvant chemotherapy,patients with tumor size less than or equal to 5cm,metastatic lymph nodes more than or equal to 4 and triple negative breast cancer had the highest survival benefit,and patients aged 50～80 years,with negative lymph node at initial diagnosis,menopausal and Her-2 positive breast cancer had the lowest survival benefit in NAC,patients aged 20～49 years,with tumor size larger than 5cm,lymph node positive at initial diagnosis,premenopausal,less than 4 lymph node metastasis,and luminal type breast cancer were associated with high recurrence risk in NAC.Changes of ER,PR and Ki-67 before and after NAC were with significant differences(P<0.05),while the changes of Her-2 were with no significant differences(P=0.754).There was no significant correlation between the changes of ER,PR and Her-2 before and after NAC wtih OS and DFS in breast cancer patients(P>0.05).Compared with patients with stable and decreased expression of Ki-67,patients with low to high expression of Ki-67 had poorer survival benefit,and this difference was statistically significant(P<0.05).Conclusion Not all patients with operable breast cancer are suitable for NAC treatment.Survival benefit should be evaluated comprehensively based on patient age,tumor size,lymph node metastasis status,molecular typing and other pathological indicators as well as breast preservation willingness,so as to develop the most suitable personalized treatment plan for patients.NAC can change the expression of ER,PR and Ki-67 in breast cancer,and the expression of Ki-67 can be considered as predictive markers of the effect of NAC.In addition,NAC can also serve as a research platform for biological markers of breast cancer.There are still many unknown areas to be explored,and more studies are needed to continue to explore the clinical value of NAC in the future.