| Backgrounds:Breast cancer,as one of the most common malignant tumor among the female of human species,is defined as a kind of malignant tumors which derive from the epithelial tissue of breast.With the continuous improvement of diagnosing and treating concepts as well as rapid development of science and technology,the general therapeutic outcome of breast cancer has been significantly enhanced,especially in the past few decades.But still,breast cancer remains listed as one major cause of death among the female population in China.Nowadays,the treatment system of breast cancer has evolved from sole surgical operation into a multidisciplinary and comprehensive pattern,which comprises radiotherapy,chemotherapy and biological target therapy,with the surgery as the core.In addition,neoadjuvant chemotherapy is widely applied in the procedure of treating breast cancer and playing quite an important role clinically.As a hot spot in breast cancer research,neoadjuvant chemotherapy is no longer limited to the application in locally advanced breast cancer,it has been used to test the sensitivity of a chemotherapy scheme,restrain micro metastases and gain a chance to implement breast-conserving surgery.According to some relevant research,breast cancer patients who achieved pathological complete remission after neoadjuvant chemotherapy tend to acquire longer disease-free survival and overall survival compared with those who didn't.However,the approximate proportion of pCR overall is just 20 percent.What makes it even worse,some few patients exhibit tumor progression in the duration of neoadjuvant chemotherapy.Certain critical aspects,such as the target patients,chemotherapy schemes,course of treatment,evaluation system of treatment effect etc.are yet to reach a consensus,which adds much difficulty to research work.In spite of so many barriers and obstacles,no one can deny the promising prospect of neoadjuvant chemotherapy.There are numerous issues waiting for further study.Precise selection of target patients,proper prediction of therapeutic effect,objective evaluation of treatment outcome have become vital.In brief,as for individualized treatment of breast cancer,it is clinically meaningful and worthwhile to dig into predictive indicators for response to neoadjuvant chemotherapy.Objective:This article is aimed at an explicitation of the relevance between pathological characteristics and NAC response,by means of a analysis of both clinical and pathological records,hoping to facilitate and inspire individualized treatment of breast cancer.Methods:A retrospective review of 168 breast cancer patients who underwent neoadjuvant chemotherapy and surgery was carried out.An aggregation of general clinical information,pre and post NAC ultrasonography reports and pathological reports was done.The relations between clinical features,Luminal subtypes of breast cancer as well as immunohistochemical indexes and status of pathological reponse were investigated by chi-square test or Fisher's exact test,the correlation of ultrasonographic shrink level and pathologic response was estimated.Statistical analysis was performed by feat of Statistical Package for Social Science Software(SPSS 23.0).Results:According to the screening criteria,168 cases were adopted into statistics in total.All of them were classified as infiltrative non-specific caner.Compared with ER positive group,ER negative group has higher proportion of pCR(13.9%vs 5.2,P =0.016).Histological stages are positively related to the incidence of pCR(Spearman coefficient=0.252,P = 0.007).pCR rate had no significant correlation with the expression levels of PR,HER-2/neu and Ki-67.Non-Luminal subtypes tended to produce more pCR cases than Luminal subtypes(P=0.07).The pCR rate of HER-2/neu over-expression subtype ranked highest with a positive statistical difference.The level of Ki-67 drops after NAC is correlated to the Miller-Payne(MP)grading system(Spearman coefficient=0.258,P = 0.001).The shrinking extent of tumor measured by ultrasonography is in accordance with pathological effect assessment(Kappa coefficient=0.483,P<0.001).Conclusion:Tumors not smaller than 3cm are more likely to earn a pathologically effective outcome.Those who are ER-negative or HER-2/neu overexpression subtype tend to acquire a higher pCR rate.The original and decline level of Ki-67 after NAC as well as histological stages are positively related with the therapeutic effect of neoadjuvant chemotherapy.Breast ultrasounography is fairly consistent with MP grading system,which is promising in evaluating the therapeutic effect of neaoadjuvant chemotherapy. |
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