Changes And Prognostic Value Of Immunohistochemical Markers In Breast Cancer After Neoadjuvant Chemotherapy

Objective: To explore the the changes of immunohistochemical(IHC)markers in breast cancer before and after neoadjuvant chemotherapy(NAC)and its prognostic value.Methods: A retrospective analysis of breast cancer patients who received neoadjuvant chemotherapy and surgery in Department of Gastrointestinal Gland Surgery,the First Affiliated Hospital of Guangxi Medical University was conducted,from Jan.2012 to Oct.2016.All of the patient's clinical and pathological data was collected and statistical analyzed.All statistical procedures were performed by SPSS software,version 22.0.Wilcoxon rank-test was used to analyze the change in the trend of ER,PR,HER2 and Ki67.The Chi-square test evaluated the changes in expression status of immunohistochemical markers.Fisher's exact test was performed when necessary.Kaplan–Meier survival curves and log rank tests demonstrated thedistribution of with disease free survival(DFS)and overall survival(OS).Results: A total of 41 women patients diagnosed with breast cancer stage?-? were included.There were 23 patients(56.1%)with stage ? and 18(43.9%)with stage ?.The median age was 47 and the average follow-up time was 27.3 months.Premenopausal cases occurred in 78%(32 cases).Forty patients were diagnosed as invasive ductal carcinoma and one patient with invasive lobular carcinoma.The regimens of NAC were mainly with antharcycline and docetaxel 20 cases(48.8%),12 cases(29.3%)with docetaxel and carboplatin and 7 cases(17.1%)with docetaxel and capecitabine.The surgery underwent by the patients were 35 cases of modified radical mastectomy,4 cases of conserving surgery and 2 cases of modified radical mastectomy and reconstruction after NAC.The median of axillary lymph node(ALN)positive after surgery is 2.There were no significant differences in the change in trend of either ER(P=0.537),PR(P=0.585),HER2(P=0.976)or Ki67(P=0.159).However,in terms of the analysis for the changes in expression of receptor status,there were significant differences in the ER(?2=23.5,P<0.001),PR(?2=15.1,P<0.001)and HR(?2=17.1,P<0.001).The DFS and OS of the patient were 21.5 months and 22.1 months,respectively.There was no significant difference between the ER,PR status after NAC relative to the DFS or OS value(P>0.05).The number of positive axillary lymph nodes after neoadjuvant chemotherapy was significantly correlated with long-term survival time,DFS(HR = 5.39 CI95% 1.88-15.5,P <0.001).Conclusions:Our study demonstrated that the switch in ER and PR status after NAC is remarkable,but the trend they switch has not been proved.The inconsistency of HER2 status expression was higher after NAC,but there was no further evidence that it was associated with neoadjuvant chemotherapy.This discrepancy may be related with the sample size or puncture biopsy.The higher the positive number of axillary lymph nodes after neoadjuvant chemotherapy,the worse the prognosis.However,the patients with clinically negative ALN did not show significant advantages in long-term survival time.