| Objective: To analyze the differences in clinicopathological features of different molecular types of breast cancer,and to summarize the risk factors that may affect the prognosis of breast cancer patients;to explore the relationship between different molecular types of breast cancer and the efficacy of neoadjuvant therapy and the factors affecting tumor recurrence and metastasis after neoadjuvant therapy.Methods:(1)Retrospectively collected and analyzed 469 cases of breast cancer patients who underwent surgery in the Affiliated Hospital of Youjiang Medical College for Nationalities from January 2017 to December 2021,and analyzed the differences in clinicopathological characteristics and prognosis among molecular types of breast cancer.(2)A further screening of 141 breast cancer patients undergoing surgery after neoadjuvant therapy from January 2019 to December 2020 was carried out,and the curative effect was evaluated according to the postoperative results.relationship,and to further analyze the influencing factors of tumor recurrence or metastasis after neoadjuvant therapy.Results:(1)Among the 469 breast cancer patients in the first part,Luminal A type accounted for 34.3%(161/469)of the total number,Luminal B type accounted for 25.8%(121/469)of the total number,and HER-2 positive accounted for 24.7% of the total number(116/469),triple-negative type accounted for 15.2%(71/469)of the total number;there were statistically significant differences in age,tumor diameter,N stage and CK5/6 expression status among the types of breast cancer(P<0.05).(2)The 3-year DFS of patients with Luminal A type and Luminal B type were 80.8% and86.1%,respectively,which were higher than those of HER-2 positive(76.7%)and triple negative(51.3%),and the 3-year DFS difference of different molecular types There is statistical significance(P<0.05).By the end of the follow-up,a total of 101 patients had local recurrence or metastasis,Luminal A type,Luminal B type,HER-2positive,and triple negative type were 25 cases,14 cases,29 cases,and 33 cases,respectively,and the metastatic sites were lung(37 cases),bone(27 cases),brain(12cases),liver(11 cases),the transfer rate of triple-negative type was higher than that of other subtypes(P<0.05).(3)Univariate analysis showed that molecular type,N stage,tumor diameter,clinical stage,high expression of Ki-67,and CK5/6 status were the related factors of 3-year DFS in breast cancer patients.Multivariate Cox regression analysis showed that histological grade,molecular subtype,tumor diameter,and vascular tumor thrombus were independent risk factors for 3-year DFS in breast cancer patients,with P<0.05.(4)Among the 141 patients who received NAT in the second part,a total of 29 patients achieved p CR,and the overall p CR rate was 20.6%(29/141).Among them,the p CR rate of Luminal A type was 19.2%(5/26);the p CR rate of Luminal B type was 12.1%(4/33);the HER-2 positive p CR rate was 23.1%(12/52);26.7%(8/30).There were 69 patients with PR,33 patients with SD,and 10 patients with PD.The ORR of Luminal A type was 61.5%,that of Luminal B type was 57.5%,that of HER-2 positive was 80.8%,and that of triple negative type was70.0%.The overall ORR rate was 69.5%(79/141).There was a statistically significant difference in ORR between HER-2 positive and Luminal B type,P<0.05.(5)By the end of the follow-up,among the 141 patients who underwent NAT concurrent surgery,a total of 29 patients had local recurrence or distant metastasis,and the metastatic sites were bone(13 cases),lung(11 cases),and liver(2 cases),brain(2 cases),bone was the most common site of distant metastasis(46.4%),followed by lung(39.3%),liver and brain metastases were less common(7.1%).(6)Univariate analysis was performed on 29 patients with recurrence or metastasis.The results showed that the pathological type,histological grade,T stage,drug resistance,p CR and MP grade were compared between the recurrence and metastasis group and the non-relapse and metastasis group.The difference was statistically significant,all P<0.05.Invasive lobular carcinoma,tissue grade III,T4 stage,drug resistance,failure to obtain p CR,and low MP grade after neoadjuvant therapy are risk factors for tumor recurrence and metastasis after neoadjuvant therapy and surgery for breast cancer.Multivariate regression analysis showed that NAT resistance was an independent risk factor for tumor recurrence and metastasis after neoadjuvant therapy for breast cancer,P<0.05.Conclusions:(1)HER-2-positive breast cancer responds better to neoadjuvant therapy than other subtypes;the incidence of tumor recurrence and metastasis is lower in those who obtain p CR.(2)Invasive lobular carcinoma,tissue grade III,T4 stage,drug resistance,failure to obtain p CR,and MP grade not reaching G4 grade or above are risk factors for tumor recurrence and metastasis after neoadjuvant therapy and surgery for breast cancer,while NAT drug resistance is an independent risk factor for tumor recurrence and metastasis after neoadjuvant therapy. |
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