| The incidence of breast cancer is increasing year by year.According to statistics,the incidence and mortality of breast cancer in women worldwide in 2020 will be24.5%and 15.5%[1],which is the first high-incidence cancer affecting the health of women in the world and in my country.Neoadjuvant chemotherapy（NAC）is the standard preoperative treatment for patients with locally advanced breast cancer or those who wish to conserve breast cancer,and pathological complete response（p CR）is considered as a prognostic surrogate endpoint[2],the prognosis of patients with p CR will be significantly improved,which has an important guiding role for the prognosis of patients with neoadjuvant chemotherapy.The prognosis of breast cancer patients who achieve p CR after neoadjuvant chemotherapy is generally good.This study starts from previous breast cancer cases,analyzes the direct or indirect factors related to neoadjuvant therapy and pathological complete remission,and seeks for the correlation.It can help the selection of diagnosis and treatment of patients with neoadjuvant chemotherapy for breast cancer in clinical practice,and thus has a certain guiding role in evaluating the prognosis of patients.Objective:To find out the independent related factors of p CR after neoadjuvant chemotherapy in breast cancer patients;to establish a prediction model to provide clinical guidance for breast cancer treatment,selection of surgical methods and prognosis of patients.Methods:The clinical data of patients with neoadjuvant chemotherapy for breast cancer who were hospitalized for the first time in the First Affiliated Hospital of Nanchang University from January 2017 to December 2021 were retrospectively analyzed.All patients completed neoadjuvant chemotherapy and underwent surgery in our hospital..The collected data mainly included age,menstruation,location,BMI,B-ultrasound imaging results before and after neoadjuvant chemotherapy,breast mass size,axillary lymph node status,molecular typing,and immunohistochemical results（ER,PR,Her-2,Ki-67）,histological grade,surgical method,and pathological classification.These data were subjected to chi-square test or Fisher’s exact calculation and Logistic univariate analysis by SPSS 23.0 software to evaluate the clinical data related to p CR after neoadjuvant chemotherapy.The receiver operating characteristic curve（ROC）curve of the p CR prediction model was drawn,and the accuracy of the model was evaluated by the area under the ROC curve.Finally,these influencing factors were drawn using R language to draw a nomogram and a calibration curve.Results:1.Among the 180 neoadjuvant chemotherapy patients included in this study,22.8%（41/180）had p CR.The blood flow signal,mass remission,molecular type and lymph node metastasis in B-ultrasound imaging reflected p CR.There were no blood flow signals in B-ultrasound after chemotherapy,the better the tumor remission,and the patients with triple-negative breast cancer and no lymph node metastasis were more likely to obtain p CR.2.The results of univariate analysis showed that the shape of the mass,blood flow signal,posterior echo,mass size,mass remission,lymph node status,ER status,PR status,Her-2 status,and ki-67 status after B-ultrasound affect the p CR rate after neoadjuvant chemotherapy.The multivariate analysis showed that blood flow signal in B-ultrasonography,tumor remission,triple-negative breast cancer and no lymph node metastasis were independent influencing factors of p CR.Conclusion:Among the patients with triple-negative breast cancer and those without lymph node metastasis in neoadjuvant chemotherapy,it is easier to achieve p CR,while the blood flow signal in B-ultrasound imaging and the remission of the mass are important factors for predicting p CR,which can provide a basis for the treatment of such patients.reference. |
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