Analysis Of The Efficacy Of Neoadjuvant Chemotherapy In Breast Cancer Patients With Lymph Node Positive And Prognosis Study

Background: Breast cancer is the highest incidence of malignancy of women worldwide.About 20%-30% have developed to locally advanced when being diagnosed,showing a large mass of breast and/or regional lymph node metastasis,Neoadjuvant chemotherapy is the standard therapy for locally advanced breast cancer currently.Hoping that neoadjuvant chemotherapy will reduce or even eliminate the primary lesions and metastatic regional lymph nodes,reduce the clinical stage,increase the chance of breast-conserving surgery,and provide more treatments for axillary lymph nodes beyond neoadjuvant chemotherapy to reduce the incidence of postoperative complications associated with axillary lymph node dissection by Neoadjuvant chemotherapy.There are many factors associated with breast cancer prognosis,including age,stage,histological grade,vascular / lymphatic invasion,the expression levels of hormone receptors(including estrogen receptor,progesterone receptor),human epidermal growth factor receptor 2 and lymph node metastasis,the axillary lymph node metastasis is an independent prognostic factor of all.The purpose of this study is to analyze the pathological response and survival of breast cancer patients with lymph node positive after neoadjuvant chemotherapy,to explore the relationship between clinical and pathological with Pathological relief and prognosisMethods: Patients collected from The breast cancer patients from the second hospital of Jilin University,the Department of Breast Surgery from January 2013 to December 2016.With lymph node metastasis,undergo neoadjuvant chemotherapy.Informationabout general clinical data,postoperative pathology before neoadjuvant chemotherapy and after,and follow-up information of patients were collected.To analyze the factors affecting the efficacy and prognosis of neoadjuvant chemotherapy for lymph node-positive breast cancer.Statistical analysis of the factors affecting the efficacy and prognosis of neoadjuvant chemotherapy by Statistics.Results: 1.The p CR rate is 16.1% after neoadjuvant chemotherapy for breast cancer patients with lymph node positive.2.The primary radical surgery is still performed with modified radical mastectomy(83.9%),and the rate of breast-conservation is only 5.1%.ALND is still the main treatment for axillary lymph nodes.Among them,27.9% of patients have SLNB before ALND,but SLNB is not used alone in the treatment of axillary lymph nodes.3.Neoadjuvant chemotherapy for breast cancer patients with lymph node positive,ER negative compared with ER positive,can obtain a higher p CR rate,with a statistically significant difference(P<0.05);HER2-positive compared with HER2-negative,obtain obtain a higher p CR rate,with a statistically significant difference(P<0.05);Compared with Ki67?30%,Ki67>30% obtain a higher p CR rate,with a statistically significant difference(P<0.05).In this study,the expression of PR has no correction with the p CR rate of neoadjuvant chemotherapy(P>0.05).4.Survival analysis shows that there is no statistically significant difference in DFS between patients with p CR and those without p CR after neoadjuvant chemotherapy for breast cancer patients with lymph node positive(Log-rank=0.04,P=0.84);.The DFS of ER-positive patients is significantly better than that of ER-negative patients(Log-rank=6.62,P=0.01);The DFS of HER2-negative patients is significantly better than that of HER2-positive patients(Log-rank=6.53,P=0.01);The expression levels of PR and Ki67 are not related to DFS(P>0.05).Conclusions: 1.Neoadjuvant chemotherapy for breast cancer patients with lymph node positive,ER-negative,HER2-positive,Ki67> 30% are more able to achieve p CR;2.Afterneoadjuvant chemotherapy for breast cancer patients with lymph node positive,DFS has nothing to do with whether p CR up.3.The neoadjuvant chemotherapy for breast cancer patients with lymph node positive,shows a better prognosis in ER-positive and HER2-negative patients.4.The neoadjuvant chemotherapy for breast cancer patients with lymph node positive,patients with axillary lymph node up to p CR,can avoid ALND.