Clinical Study Of Neoadjuvant Efficacy And Prognosis In Patients With Triple Positive Breast Cancer And HER-2 Overexpression Breast Cancer

Objective:To compare the clinicopathologic characteristics and the difference of efficacy after neoadjuvant chemotherapy between the patients with triple positive breast cancer and human epidermal growth factor receptor-2overexpression breast cancer,to analyze the effect of estrogen progesterone receptor expression level on neoadjuvant efficacy of HER-2 positive breast cancer,and to compare he survival time of patients with triple-positive breast cancer and HER-2 overexpression breast cancer,in order to provide reference for clinical precision treatment.Methods:Patients with triple-positive breast cancer and HER-2overexpression breast cancer who were admitted to the Affiliated Hospital of Southwest Medical University from January 1,2019 to July 31,2022 and eligible for inclusion in this study were retrospectively collected.Chi-square test,rank sum test or Fisher’s exact probability method were used to analyze and compare the clinicopathologic features of the two groups of patients and the difference in efficacy after receiving neoadjuvant therapy.The risk factors affecting the efficacy of neoadjuvant therapy were analyzed by binary logistic regression.At the same time,8921 patients with triple-positive breast cancer and 3477 patients with HER-2 overexpression breast cancer from January 1,2000 to December 31,2019 were retrospectively analyzed using the SEER database.km curve was used to compare the survival time.Results :A total of 323 patients eligible for inclusion were collected in this study,including 169 patients with triple-positive breast cancer and 154 patients with HER-2 overexpression type breast cancer.After neoadjuvant therapy,190 patients achieved p CR,and 133 patients did not achieve p CR or non-PCR.(1)Compared with patients with triple-positive breast cancer,the proportion of patients with HER-2 overexpression breast cancer with high histological grade,Miller-Payne system grade 4-5,partial remission,p CR,and Ki-67 index decline ratio ≥50% after neoadjuvant therapy were all higher(all P < 0.05).There were no significant differences in other characteristics,such as age,family history of breast cancer,tumor size,lymph node metastasis,TNM staging,neutrophil-lymphocyte ratio,lymphocyte-monocyte rate,Ki-67 expression,surgical method,and lymph node response after chemotherapy(P>0.05).(2)In triple positive breast cancer patients,when ER expression was 1%-30%,the proportion of MP grade 4-5 was higher,and it was easier to reach p CR(P <0.05).(3)logistic regression multivariate analysis of risk factors affecting p CR was performed on indicators with statistical significance in univariate analysis.It was found that the higher histological grade,higher Ki-67 expression,higher neutrophil-lymphocyte ratio,and negative ER and PR status were more likely to achieve p CR after neoadjuvant therapy(OR < 1,P < 0.05).And the higher ER expression,the less p CR(OR>1,P < 0.05).(4)The overall survival rate of triple positive breast cancer was higher than that of over-expressed HER-2breast cancer(P < 0.001).Conclusions:According to the results of this study,the efficacy of neoadjuvant chemotherapy in breast cancer patients with HER-2overexpression is better than that in patients with triple-positive breast cancer.Positive hormone receptor(ER and PR),low expression of Ki-67,lower histological grade,and lower neutrophil to lymphocyte ratio are less likely to achieve p CR.The prognosis of triple positive breast cancer is better than that of breast cancer patients with HER-2 overexpression.