| Objective: Preoperative chemotherapy of breast cancer,also known as neoadjuvant chemotherapy,induction chemotherapy or initial chemotherapy.At present it widely applies to inoperable locally advanced breast cancer and patients who want a breast-conserving surgery.to achieve the control of local disease and the reduction or eradication of micrometastatic distant disease clinical also found that preoperative chemotherapy reached pathological complete remission its long-term survival will be improved.Many factors affect the pathologic response,to be further refined;for the primary tumor after preoperative chemotherapy and the relationship between different remission status and prognosis of axillary lymph node is still controversial,this study observed after chemotherapy of primary tumor and lymph node of different pathological remission,analysis of clinical pathological characteristics and prognosis of combined thinking the influence factors in order to provide more accurate basis for expectations of future breast cancer before chemotherapy.Methods:Retrospective analyse the cases of the Fourth Hospital of Hebei Medical University Breast Center admitted II-III period from January 2010 to November 2011 need to preoperative chemotherapy in patients with primary breast cancer.evaluate the clinical efficacy in time,choose the right time to surgical servise.After surgery we analyzed the five years DFS and OS combined with tumor and ALN pathological conditions.Results:January 2010 to November 2011,a total of 152 breast cancer patients receiving preoperative chemotherapy.The preoperative primary chemotherapy and axillary lymph node and even the ipsilateral locked lymph nodeswere confirmed by hollow needle aspiration to confirm the cancer metastasis.in the process of analysis of the factors affecting the rate of pCR,in terms of the complete pCR,the people of non-Luminal obtain the complete pCR easily,the rates of pCR are 8.0%(Luminal type),28.6%(HER2type),33.3%(triple negative type)respectively.There was significant difference between the groups(P=0.001),in the term of primary tumor pCR,the subgroups of non-Luminal type and combined regimen are more likely to get tumor pCR(P=0.002,0.018),in the term of lymph node pCR,the people of no skin edema or involved and II stage clinically are more likely to get lymph node pCR(P=0.031,0.027).In patients with HER2 gene amplification,the use of targeted therapy improved the rate of complete pCR and tumor pCR(both P=0.032).According to the pathological evaluation of specimens after operation,respectively in the following subgroups were analyzed by DFS and OS,between the complete pCR and incomplete pCR,the complete pCR and completely non-pCR,complete pCR and only tumors pCR,complete pCR and only lymph node pCR,only tumor pCR and only lymph node pCR,only tumor pCR and completely non-pCR,only lymph node pCR and completely non-pCR,tumor pCR and non-tumor pCR lymph node pCR and non-lymph node pCR.Found that the DFS of the subgroup of complete pCR increased significantly as the incomplete pCR and completely non-pCR,the difference was statistically significant(P=0.037,0.015),also found that the DFS of the subgroup of only lymph node pCR increased significantly as the group of complete non-pCR(P=0.023),but there is no significant difference between the two groups in terms of OS.the DFS and OS of the subgroup of lymph node pCR increased significantly as the group of non-lymph node pCR(P=0.003,0.024),There was no significant difference between other groups.In the analysis of relationship between different pCR and prognosis in the molecular subtypes,only found in Luminal B type,complete pCR compared with incomplete pCR,only there were significant differences inDFS(P=0.049),compared with complete non-pCR,also found significant difference in the DFS(P=0.024),Lymph node pCR compared with non lymph node pCR,there were significantly different only in terms of DFS(P=0.008),tumor pCR compared with non tumor pCR,there were significantly different only in DFS(P=0.046),there was no significant differences in OS,In non-Luminal subgroup,the lymph node pCR was significantly improved in DFS and OS compared with non-lymph node pCR,the difference was statistically significant(P=0.037,0.025),No statistical difference was found in other molecular subtypes.In the subgroup of the number of positive lymph nodes,pathological staging,molecular typing,pathological grading of MP,in the single factor analysis of K-M curve,with increasing of number of positive lymph nodes and pathological stage,DFS and OS were significantly decreased,the difference was statistically significant(P<0.001),in addition,with the increasing of MP level,the DFS of patients increased significantly(P=0.045),but no significant difference was found in OS.In multivariate analysis of the number of positive lymph nodes,pathological staging,pathological grading of MP,no statistically significant difference was found between the major components.In patients with HER2 gene amplification,the use of targeted therapy significantly improved the DFS and OS(P=0.01,0.03).There was no significant difference in DFS and OS when analysed the change of Ki-67 and molecular subtypes.In 58 recurrent and dead patients,the recurrence and death rate of pure lymph node pCR was 23.3%,recurrence and death rate of pure tumor pCR was 33.3%.the recurrence and death rate of completely non-pCR was46.5%,the difference was statistically significant(P=0.021).the recurrence and death rate rate of LuminalA type was 23.8%,the recurrence and death rate of LuminalB type was 42.4%,the recurrence and death rate of triple negative type was 27.8%,the recurrence and death rate of HER2 type was42.9%.the difference was not statistically significant(P=0.314).Conclusion:1 patients of non-Lumimal type are more likely to get compete pCR,patients of non-Lumimal type and the treatment of combined regimen are more likely to get tumor pCR,patients without skin edema or involved and patients of II stage easierly access to lymph node pCR.2 The DFS of patients with complete pCR was improved significantly,except for complete pCR,the DFS and OS of patients with lymph node pCR was better,In the Luminal B subtype,DFS was significantly improved in all patients who received pCR,In non-Luminal subgroup,the lymph node pCR was significantly improved in DFS and OS compared with non-lymph node pCR.3 The prognosis of patients is associated with the MP grade,the number of positive lymph nodes,and pathological stage.4 Patients with complete pCR and pure lymph node pCR had the best prognosis in terms of recurrence mortality,and molecular type did not affect the prognosis after preoperative chemotherapy.5 After preoperative chemotherapy,the change of Ki67 and molecular type had no effect on the prognosis. |
