Research On Indicators To Evaluate Prognosis Of Patients With Breast Cancer After Neoadjuvant Chemotherapy

Objective: Neoadjuvant chemotherapy has gain more attention from doctor because of improvement rate of locally advanced breast cancer resection and breast conservation.However,a part of patients get recurrence and metastasis in a relatively short period of time after neoadjuvant chemotherapy.There is no unified conclusion to evaluate the effectiveness of neoadjuvant chemotherapy and the long-term outcome predictors of survival.How can we decide to do mastectomy or breast conserving surgery.Therefore,this study aims to compare the changes of the indicators before and after neoadjuvant chemotherapy,such as lymph node status changes and ER,PR,KI67,RCB grading,NEO score,and then explore index could predict the prognosis of breast cancer.Methods: By collecting the clinical data of 83 patients who went through neoadjuvant chemotherapy from affiliated hospital of Guangzhou medical university from 2012 to 2017,we retrospective analyze dynamic changes of the molecule indicators after neoadjuvant chemotherapy,through the statistical software SPSS 17.0.We use t test for the measurement data,chi-square test for the categorical data,and nonparametric rank and inspection for rank data.As for survival analysis,we use the Kaplan Meier method and inspect by the three methods,log-rank,breslow,tarone to decide whether it makes sense.We define P < 0.05 makes significant in the study.We analysis the relationship between ER,PR,KI67,lymph node status and prognosis of breast cancer by single factor correlation analysis.Results: 1,The rate of patients of triple negative breast cancer get clinical benefit is 86.7% and the pCR rate is 26.7%,while pCR rate of Her2 overexpression is 23.5%.76.7% of luminal type benefit from neoadjuvant chemotherapy and the pCR rate is 5.8%,much more lower than the other two types.(p < 0.05).2,The axillary lymph node of 63 patients are positive before neoadjuvant chemotherapy,while the other 20 patients,axillary lymph node are negative.As for patients with positive lymph node,the DFS is 38 months,and significant different from that of patients with axillary lymph node negative(p = 0.022).In our study,Lymph nodes of 10 patients change from positive to negative after neoadjuvant chemotherapy,2 cases change from negative to positive.DFS gets 40 months for the patients with positive axillary lymph node,and their OS is 53 months.As for patients with negative axillary lymph node,DFS reach 53 months and OS gets 60 months.DFS has obvious difference between these two groups(p = 0.014),while OS has no differences(p = 0.169).However,patients with more than 2 positive axillary lymph nodes have lower overall survival compare with patients less than 2 positive lymph nodes.(60 months VS 42 months).3,The patients get longer OS and DFS if Ki67 index decrease after neoadjuvant chemotherapy,and patients without Ki67 decrease has lower survival,suggests Ki67 protein expression levels can be used as an indicator to evaluate patients out come after neoadjuvant chemotherapy.4,After neoadjuvant chemotherapy,ER,PR,Her2 have change to some degree.21 cases have risen with ER and 28 cases were flat or falling.12 cases have risen with PR and 31 cases were flat or falling.Only 5 patients have change in Her2.Whether ER or PR has make difference in the prognosis of patients.The DFS of patients with ER decrease is 45 months,while ER increase group is 42 months.The DFS of patients with PR decrease is 47 months,while ER increase group is 44 months.The DFS of patients with HER2 decrease is 37 months,while ER increase group is 45 months.5,The DFS of patients with RCB 3 is 21 months,while RCB 2/RCB1/RCB0 group is 49 months.The OS of patients with RCB 3 is 39 months,while RCB 2/RCB1/RCB0 group is 56 months.RCB classification has certain guiding significance to the evaluation prognosis of breast cancer,patients with lower RCB classification have well prognosis.The DFS and OS are 46 months and 58 months for NEO higher than 4,indicating that NEO have the effect of long-term prognosis evaluation.Conclusion: 1.The Luminal type benefits less in neoadjuvant chemotherapy compare with that patients of Her2 expression and triple negative.2.Negative axillary lymph node has longer survival compare with patients with positive axillary lymph node.For patients with positive axillary lymph node after neoadjuvant chemotherapy,the prognosis of axillary lymph node metastasis less than 2 has better prognosis;3.We can evaluate prognosis of patients through Ki67,RCB,NEO after neoadjuvant chemotherapy.