The Curative Effect And Influencing Factors Of Neoadjuvant Chemotherapy In Breast Cancer

ObjectIn recent years,breast cancer has become a serious threat to women's health in our country,due to it's rapidly rising of incidence.And the operation-based comprehensive treatment has become the miansteam of the therapeutic method for breast cancer.Neoadjuvant chemoherapy is currently accepted as a therapeutic choice for any stage of patients with breast cancer.Its application has given many inoperable patients with surgery chance,even breast-conserving surgery,finally improving the quality of the survival as well as their prognosis.but there are still some patients couldn't benefit from the neoadjuvant chemotherapy.Therefore,it was particularly important to develop a reasonable and individualized neoadjuvant chemotherapy for those patients.Methodreview the patients that were admitted to Qilu hospital of Shandong University from 2010 to August 2016,consult their medical records to make retrospective review,collected the clinical data including patients' basic information,Physical examination situation,imaging performance,laboratory examination,pathological diagnosis,lymph node status at the first visit and after neoadjuvant chemotherapy,regimen,dose and cycle of neoadjuvant chemotherapy,operation methods.Acquired their chemotherapy,radiotherapy,endocrine therapy after surgery,side effects,recurrence and survival condition through telephone follow-up.The clinical stages before neoadjuvant refer to the TNM standard of UICC;clinical evaluation refer to the Resistl standard made by UCCI;histopathology evaluation refer to the Miller Payne Grading system;the histological results was classified by the Luminal standard.The data analysis conducted by software SPSS 23.0.Use chi-square test to analyze the interation between categorical variable and efficacy of neoadjuvant chemotherapy;use independent-samples T test to analyze the ralationship of continuous variables and efficacy of neoadjuvant chemotherapy;use paired test to analysis the clinical biomarker and Pathological indicators changed by neoadjuvant chemotherapy.Use logistic regression to analyze the variables which are statistically significant after single factor test.Use Kaplan-Meier method and COX regression to analyze the effect of different fectors on survival.And the difference is statistically significant with the P value<0.05.Result:1.This study included 343 patients with breast cancer,all performed surgery after NAC,Postoperative pathology showed that 28 people achieve pCR,The pCR rate is 10.4%.By the end of follow-up,?patients were followed,the rate of follow-up is%.2.Analysis of the influence factors on curative effect:Use pCR as effectiveness evaluation index,these patients that without inverted nipple(P = 0.008),no calcifications on mammogram(P = 0.009),no obvious mass can be touched after NAC(P<0.001),whether belongs to Luminal type(P = 0.044),PR negative(P = 0.028)are more likely to get higher pCR rate,and the difference was statistically significant.triple negative patients have higher pCR rate than other types,and the difference is statistically significant with Luminal B type(P = 0.008).Use pathologic majority response as effectiveness evaluation index,these patients that Delivery times less than 1(P = 0.028),no obvious mass can be touched after NAC(P<0.001),higher Ki67 expression(P = 0.039)are more likely to get higher pathologic majority response rate,and the difference was statistically significant and the T stage classified by ultrasound(P = 0.028),Luminal classification(P = 0.037),histological grade(P = 0.022),the cycles of chemotherapy(P = 0.022)are all have significant correlation with pathologic majority response.Binary Logistic regression analysis found that the physical examination situation after NAC(P = 0.012)and inverted nipple(P = 0.026)can be used as an independent predictor of pCR.Histological grade(P = 0.024),physical examination situation after NAC(P = 0.032)can be used as an independent predictor of pathologic majority response.Chemotherapy regimens(P = 0.005)and the cycles of chemotherapy(P<0.001)can be used as an independent predictor of clinic remission.3.The influence of drugs on curative effect:In ET regimens,complete at least six cycles of chemotherapy suggest higher pathologic majority response rate(P = 0.004),CR rate(P = 0.044)and clinical remission rate(P = 0.003).High-dose intensity suggests a better curative effect,but there is no statistically significant difference.4.breast surgeon prescribing habits research:In recent 7 years,ET regimen form the majority of NAC(46.6%),CEF regimen's application reduced while TEC regimen's application increased year by year,chemotherapy regimens in different years have significant difference(P<0.001).according to the research,we found the year,patients'age,nipple discharge,molecular classification,histological grade,ER and PR status are have significant effects on the choose of chemotherapy regimens in clinical practice.But only the year of treatment and the patient's age can be used as independent predictors of clinical choose(P= 0.013,P = 0.004).5.Prognostic factors analysis:Sites of recurrence and metastasis(P=0.003)?bone marrow suppression(P=0.013)?radiotherapy(P<0.001)?lymphedema(P=0.048)?pathologic majority response(P=0.044)?pCR(P=0.005)?whether belongs to Luminal type(P=0.004)?stages of tumor divided by Ultrasound(P<0.001)and physical examination(P<0.001)before neoadjuvant chemotherapy?the ratio of metastatic LN to detected LN(P=0.001)are significantly correlated with patient survival.COX regression found that the ratio of metastatic LN to detected LN(P=0.003)?whether belongs to Luminal type(P=0.002)?pathologic majority response(P=0.02)can be used as independent factors for the survival of patients after NAC.Conclusion1.physical examination after NAC can be used as an independent predictor of pCR and pathologic majority response.Histologic classification can be used as an independent predictor of pathologic majority response.Chemotherapy regimens and cycle can be used as independent predictors of clinical remission.2.The chemotherapy regimens influence the curative effect,and adequate dosage and duration indicate a better effect.3.we should further strengthen the awareness of Individualization of neoadjuvant chemotherapy to benefit the patients.4.the ratio of metastatic LN to detected LN(P=0.003)?whether belongs to Luminal type(P=0.002)?pathologic majority response(P=0.02)can be used as independent factors for the survival of patients after NAC.