Analysis Of Prognostic Determinants And Adjuvant Chemotherapy Effect Of The Medium Level Risk Patients With Breast Cancer

Objective: In the past few years, the morbidity of breast cancer kept growing in our country, but as the rapid developmemt of individual treatment based on standardized comprehensive treatment, the patients'risk of death was gradually going down. Since breast cancer is a kind of cancer with high heterogeneity, it has a big diversity in biological behavior, even different individuals have the same clinicopathologic features, prognosis could be different. According to St. Gallen's common acknowledge, it divides the recurrence risk into high, medium and low level, it also has some differences in recurrence rick and prognosis between different levels. It is not sure that whether had different prognostic factors at the medium risk level risk.So far, the adjuvant chemotherapy of breast cancer still focuses on anthracyclines, and in the recent years, the application of Taxanes has made many patients get the benefits of their survivals. According to the guide in the adjuvant chemotherapy of the medium risk level patients, it suggests that the therapy should focus on anthracyclines, and targets of the application of the medium risk level patients'OS are still not centain.So in this paper, 248 cases of breast cancer patients at the medium risk level were reviewed, applied Cox proportional hazard model to analyse the influence of clinicopathologic feature and treatment about breast cancer prognosis of the medium risk level patients,and compare DFS of those people who apply anthracyclines with who apply Taxanes in the adjuvant chemotherapy, analyse whether Taxanes would improve prognosis of breast cancer patients at the medium risk level and whether Taxanes fit for subgroups among breast cancer patients at the medium risk level, guide therapists to make more optical treatment in the future and provide new basis for new individual treatment.Methods: This study collected the Fourth Hospital of Hebei Medical University, Department of Medical Oncology during the March 1th, 2007 to December 31th, 2009 was admitted to a clear pathological diagnosis of 248 cases of breast cancer patients at the medium risk level, the dates were input to ACCESS database after encoded. A follow-up study continuing diagnose was made by out-patient follow-up review or make phone-call to those patients until December 31th, 2010. For this phase, the operation time was looked as the starting point and the end point can be decided as the death of the patient, lost in contact or the last time of diagnose. During this period, it would be full dates if patients died of diseases related breasts cancer, but it would be handled as censored value if patients survived or die of other diseases.All confirmed analyses data were performed and by using SPSS13.0 software package. Reference to relevant research at home and abroad, and combined with clinical practice situation, age, tumor size, axillary lymph node metastasis and other clinicopathological features and the adjuvant treatment methods to quantify the integrated assignment, using Cox proportional hazard model analysis, come to affect the breast cancer surgery After the patients disease-free survival (DFS) and overall survival (OS) of the prognostic factors. Using Kaplan-Meier method (Kaplan-Meier) statistical analysis make a analysis in DFS of the medium risk level patients who applied anthracyclines regimen or Taxanes contained regimen in adjuvant chemotherapy . Chi-square test was used for the enumeration data comparison. All tests were performed at the?P<0.05 level of significances.Results:1 A survival situation: the medium risk level patients in the whole group 1,2,3-year overall survival rate was 96.4%,89.9%,84.4%; the whole group 1,2,3-year disease-free survival rate was 99.6%,97.4%,93.6%.2 The COX analysis of prognostic factors in the medium risk level patients.2.1 On univariate analysis of the medium risk level patients'DFS Tumor size, metastasis situation of ALN, ER/PR expression, HER-2 expression, adjuvant chemotherapy and adjuvant endocrine treatment have an significant effect on DFS (P<0.05)2.2 On multivariate anysis of the medium level risk patients'DFSTumor size,metastasis situation of ALN and adjuvant chemotherapy are independent prognosis factors influencing DFS.2.2.1 Tumor size: set T1 group as reference criterion (RR=1), the recurrence risk of T2 group and T3 group is 2.841 times (P=0.003)and 4.348 times (P=0.016) than that of T1 group, tumor size is an independent prognostic factor influencing DFS of the patients who are in the medium level risk(P=0.003), bigger tumor size has relatively higher recurrence risk.2.2.2 The metastasis situation of lymph node: set N0 group(the negative group of metastasis of lymph node)as reference criterion (RR=1), the recurrence risk of group which has N1 group(1-3 lymph nodes metastasize)is 4.148 times than that of reference criterion (P=0.000), metastasis situation of lymph node is an independent prognostic factor influencing DFS, the positive group of metastasis of lymph node has a relatively higher recurrence risk than that of the negative group.2.2.3 Chemotherapy regimen: set the group applying anthracyclines regimen as reference criterion (RR=1), recurrence risk of the group containing taxanes regimen is 0.368 times than that of group only applying anthracyclines regimen (P=0.011), taxanes contained regimen has a negative correlation with postoperative recurrence, taxanes regimen has a lower recurrence risk than anthracyclines regimen, having a statistical difference (P<0.05).2.3 The prognostic factors influencing the medium risk level patients'OS:only univariate factor shows the metastasis situation of ALN3 Comparison of postoperative adjuvant chemotherapy (anthracyclines regimen compared Taxanes regimen)3.1 Balance testChoosing chemotherapy regimen as age, menstrual conditions, tumor size, clinical stage, ER,PR expression and HER-2 expression.The balance test are indicating there were no statistically significant difference betweent the two groups.3.2 Comparison of DFS among the medium risk level patients(In the group,total DFS is patients'average DFS)3.2.1 Patients'average DFS in the group only applying anthracyclines regimen: 58.13 months. Patients'average DFS in the group applying Taxanes regimen: 65.89 months. According to the anysis of statistics, there is a significant difference (P=0.024).3.2.2 Further subgroup analysis of influencing patients'DFS showed:3.2.2.1 tumor size Among patients with tumor size>2cm, the group containing taxanes regimen obliviously prolong the DFS of patients than the group of anthracyclines regimen does, having a statistical difference (P=0.016); but among patients with tumor size≤2cm, comparing their DFS, there is no statistical difference between two groups (P=0.387).3.2.2.2 ER/PR expressionAmong patients with ER/PR double negative, the group containing taxanes regimen obliviously prolong the DFS of patients than the group of anthracyclines regimen does, having a statistical significance (57.18 months vs 46.04 months ,P=0.047);but for the patients with ER and/or PR positive, comparing their DFS, there is no statistical difference between two groups (61.54 months vs 55.18 months ,P=0.160).3.2.2.3 HER-2 expressionAmong patients with HER-2 (+++), the group containing taxanes regimen obliviously prolong the DFS of patients than the group of anthracyclines regimen does, having a statistical difference (61.75 months vs 45.23 months ,P=0.027);but for the patients with HER-2 (-/+) and HER-2(++), comparing their DFS, there is no statistical difference between two groups (P>0.05).3.2.2.4 the different risk factorsIn N01 group(negative?group?of?metastasis?of?lymph?node?and?combine?one dangerous?factor), DFS is 64.81 month among anthracyclines group, DFS is 42.21 month among taxanes group, there is no statistical significance (P=0.426);In N02 group(negative group of metastasis of lymph node and combine dangerous factor≥2), DFS is 55.15 month among anthracyclines group, DFS is 69.58 month among taxanes group, there is statistical significance (P=0.002);In N1 group(1-3 lymph nodes metastasize), DFS is 62.38 month among anthracyclines group, DFS is 57.73 month among taxanes group, there is no statistical significance (P=0.527).3.2.2.5 Comparison among different age groups,different menopause situations,different metastasis situations of lymph node, there is no statistical difference between two groups (P>0.05).Conclusion:1 The independent prognostic factors of disease‐free survival (DFS) of those medium risk level patients are: tumor size, metastasis situation of ALN and postoperative adjuvant chemotherapy.2 Among the medium risk level patients, adjuvant chemotherapy containing taxanes regimen can obliviously prolong DFS of the patients with tumor size bigger than 2 cm ,ER/PR double negative, HER-2(+++).3 In the medium level risk patients with breast cancer, no matter the metastasis situations of lymph node (0-3) is, the anthracyclines add Taxanex cannot extend patient'DFS when take the adjuvant chemotherapy.4 In the medium level risk patients with breast cancer,when negative group of metastasis of lymph node and combine any dangerous factor(pT>2cm, levelⅡ-Ⅲ, have widely tumour vasalgia infiltration, ER and /or PR(-), HER-2/neu gene extend or protein over expression, age <35)≥2, the anthracyclines add Taxanex can extend patient'DFS when take the adjuvant chemotherapy.