The Evaluation Of Neoad Juvant Chemotherapy For Breast Cancer Staging Ⅱ And Ⅲ

Objective:To investigate the relationship between the efficacy of neoadjuvant chemotherapy and chemotherapy regimens, clinical staging, chemotherapy cycles, the dose density. ER/PR. HER-2and Ki67efficacy predictive value, and analyzes the change of hormone receptor before and after new adjuvant chemotherapy.Methods:We retrospectively analyzed85patients with IIA-IIIC stage breast cancer in January2010to May2012in our hospital, according to different chemotherapy regimens, the patients were divided into anthracycline-based (AC/FAC/FEC scheme), anthracycline+paclitaxel class(TAC/TEC/FEC-T/FAC-T plan), paclitaxel plus trastuzumab(TCH/XTH scheme) and platinum(TL, TP, NL) four groups. According to the RECIST1.0solid tumor curative effect evaluation standard to evaluate curative effect of chemotherapy, the treatments were repeated every14or21days and the therapeutic effects were observed two cycles later. They accepted about2-6cycles of neoadjuvant chemotherapy before they had surgical treatment. All of the patients accepted surgical treatments and all of them finished the chemotherapies. We judgment clinical curative effect with the application of clinical evaluation (clinical touch, color dopplar ultrasound, breast X-ray radiography, breast MRI) and postoperative pathologic diagnosis. We use immunohistochemistry to detect the expression of ER、PR、HER-2、Ki67the before and after neoadjuvant chemotherapy.Results:The different chemotherapy regimens had no statistically significant with the efficacy of neoadjuvant chemotherapy (P=0.063), which reached the highest CR+PR (%) for paclitaxel plus trastuzumab followed by anthracycline; the pCR+tpCR (%) platinum the highest, followed by paclitaxel plus trastuzumab.There was a significant difference between the clinical staging and the efficacy of neoadjuvant chemotherapy (P=0.034), in which CR+PR (%) was the highest in stage ⅢC, followed by stage Ⅱ A; while pCR+tPCR (%) stage IIIC was the highest, followed by stage ⅡB.There was a significant difference between chemotherapy cycles (chemotherapy cycle≤2cycle,2-4cycle,4-6cycle) and the efficacy of neoadjuvant chemotherapy (P=0.000), in which the efficacy of neoadjuvant chemotherapy was the best in4-6cycle, followed by2-4cycle,2cycle the worst; and CR+PR (%) were100%,76.8%,22.2%respectively, pCR+tPCR (%) was25%,14.3%,0%respectively.2weeks intensive and3weeks conventional chemotherapy and the efficacy of neoadjuvant chemotherapy showed no significant difference (P=0.662).After neoadjuvant chemotherapy imaging in the maximum diameter of2.0cm (0to7.0cm) compared with chemotherapy before imaging-bit maximum diameter of3.8cm (1.3to18.0cm) significantly decreased (Z=8.616, P=0.000). The clinical efficacy:CR11cases, PR54, SD18, PD2, clinical RR76.5%(65/85). After eight cases of pCR (8/85,9.4%); in5cases tpCR (5/85,5.9%).85cases of postoperative axillary lymph node metastasis:53cases of positive and negative in32cases; compared neoadjuvant chemotherapy before (axillary lymph node was positive in69cases, negative in16cases) were significantly different (X2=7.432, P=0.006).No statistically significant correlation between the efficacy of neoadjuvant chemotherapy and molecular typing and ER, HER-2, Ki67and age and other factors, a significant difference with the PR status. On univariate analysis, the degree of tumor shrinkage was considered significant with PR, pathological type, primary tumor size, but not with age, histological grade, clinical stage, chemotherapy regimens, chemotherapy cycle, ER, HER-2and Ki67. Neoadjuvant chemotherapy before and after breast cancer tissue ER, PR, HER-2expression change was statistically significant, while the expression of Ki67in the number of statistically significant differences before and after neoadjuvant chemotherapy.The major toxicities are myelosuppression, cardio toxicity, gastrointestinal reactions, peripheral nerve toxicity, mostly grade1-2, which can be tolerated.Conclusion:1、Neoadjuvant chemotherapy for locally advanced primary breast cancer preoperative chemotherapy can effectively control the tumor.2、The efficacy of neoadjuvant chemotherapy has correlation with clinical stage and chemotherapy cycles, and no significant correlation with the chemotherapy regimens and dose density. Increase cycle can increase the effect of chemotherapy,4-6cycle of NACT curative effect is better than that of2-4cycle and cycle≤2cycle.3、Neoadjuvant chemotherapy and molecular typing, ER, HER-2, Ki67 and age and other factors have no correlation; PR-negative patients are more sensitive to chemotherapy and benefit more from chemotherapy. Of PR status, pathological type, primary tumor size are predictors of tumor shrinkage.4、Neoadjuvant chemotherapy does not change the level of expression of ER、PR、HER-2, but the number of Ki67expression change before and after neoadjuvant chemotherapy.5、The major toxicities are myelosuppression, cardio toxicity, gastrointestinal reactions, peripheral nerve toxicity, mostly grade1-2, which can be tolerated.