| In recent years, breast cancer has the trend of younger onset age and rising incidence rate, the Europe and the United States are in the3%annual rate of growth, which has become the first female incidence of malignant tumor. Many factors are closely related with prognosis of invasive breast cancer, how to use the model making an accurate assessment of prognosis according to clinicopathologic feature, classification and specific target detection results of patients to guide to the best treatment, so as to improve the survival rate and the quality of lives, it has important clinical significance. This study made a multiple factors analysis of clinicopathologic feature, tumor classification and specific indexes influencing on the prognosis, and established a postoperative mathematical model for choosing the best treatment program for invasive breast cancer patients, which can provide guidance for the selection of treatment method and the judgment of prognosis of patients with invasive breast cancer.This study made a detection of laboratory indexes of hormone receptors in invasive breast cancer patients (ER, PR), human epidermal growth factor-2(HER-2) and nuclear proliferation marker (Ki-67) by using immunohistochemistry (IHC) detection method and the HER-2(++) expression using fluorescenceinsitu hybridization (FISH) technique detection method. Made a multiple-factor analysis using all the index above combined with the treatment status of clinicopathologic feature, therapeutic status and follow-up data of patients. All the relevant information was made a COX analysis and according to principle of establishment of the Nottingham prognostic index (NPI) and the influence degree of each factor on the prognosis of invasive breast cancer to establish the model and make a verifies.The main results are as follows:1. In416cases of patients,178cases were ER negative (42.79%),238cases were ER positive (57.21%);198cases were PR negative,218cases were PR positive;188cases were Ki-67≤14%(45.19%),228cases were Ki67>14%(54.81%);124of373cases of patients were HER-2positive gene amplification, accounted for33.24%.2. Randomly selected288cases of invasive breast cancer patients,258cases with3years disease-free survival, accounting for89.58%;5years disease-free survival in244cases, accounting for84.72%.3. Single factor Kaplan-Meier analysis results of the clinical pathological characteristics and auxiliary therapy influencing on prognosis showed that, the age of invasive breast cancer patients had no significant correlation with prognosis (P>0.05); tumor size, TNM stage, ER expression, HER-2expression, Ki-67expression and lymph node status, histological grade had a significant correlation (P<0.05) with prognosis; the single factor analysis for the related auxiliary treatment showed that, whether being given the new auxiliary chemotherapy and radiotherapy had no significant effect (P>0.05) on3years and5years DFS of patients, but the length of using postoperative chemotherapy cycle and the use of endocrine therapy had a significant difference (P<0.05) effect on prognosis of patients.4. The analysis of the prognostic effect of interaction between the prognosis prediction factors and therapeutic intervention factors showed that, the expression of ER had significant positive correlation with PR, and which was obviously negative correlated with the expression of HER-2and Ki-67; using the endocrine therapy can effectively improve the tumor free survival of patients with ER positive expression. HER-2had a significant positive correlation with Ki-67expression more than6cycle chemotherapy can effectively improve the tumor free survival rate of patients with over expression of HER-2and Ki-67expression more than14%after surgery.5. Made a COX regression analysis for clinical data of288cases of patients, basing on the effect degree on prognosis, age, tumor size, lymph node status, ER expression, HER-2expression and Ki-67expression were used to establish the prognosis model, and the clinical date of other100cases who were not used for the establishment of model was made for validation, the coincidence rate of prognosis estimation value and the actual value was as high as93.00%. The establishment of the mathematical model can effectively guide to the choice of the best treatment options and make effective prediction of its prognosis in the clinical work. |
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