The Effect On Changes Of Molecular Biological Makers And Prognosis Between Pre-and Post-neoadjuvant Chemotherapy Of Breast Cancer

Objective: The incidence of breast cancer is increasing year by year throughout the country,which has become an important factor affecting the health of women and the quality of life.Neoadjuvant therapy(NAC)is one of the treatments of primary breast cancer,that can reduce the clinical stage,tumor resection and to increase breast conserving opportunities.This study aims to explore changes of molecular biological makers between pre-and post-neoadjuvant chemotherapy,and analysis the prognosis of changes of the molecular biology makers.Methods: A total of 280 patients with pathologically confirmed breast cancer and standardized neoadjuvant therapy were examined retrospectively from January 2012 to December 2013 in the breast center of the Fourth Hospital of Hebei Medical University.According to the experimental design,130 patients with postoperative non-PCR and complete data were selected.The changes of the expression levels of ER,PR,Her-2 and Ki-67 between preand post-neoadjuvant chemotherapy were analysed and the influence of these changes on DFS and OS also explored.Follow-up methods were telephone follow-up,visiting,rehospitalization,hospital visiting,household registration.Follow-up time was starting the point of operation date,and the median follow-up time was 49 months,follow-up rate was 96%.The end point events were defined as recurrent metastasis events or died of mammary cancer-related and related disease events.Disease-free survival(DFS)was defined as the time from surgical treatment to tumor recurrence or death due to disease progression.Overall survival(OS)was defined as the time from surgical treatment to death due to any cause.If the patient did not have an end point at the end of follow-up,it was referred to as censorship.All data wasrecorded in SPSS24.0 for statistical analysis.Results:1.Changes in molecular biological makers before and after NACAmong the 130 patients who entered the group,there were 9 cases(6%)in ER stable negative group and 79 cases(61%)in ER stable positive group.The ER increase group was 13 cases(10%)and the ER decrease group was 29cases(22%).There were 20 cases(15%)in PR stable negative group and 37cases(28%)in PR stable positive group.The PR increase group was 16cases(12%)and the PR decrease group was 57 cases(43%).Among the 130 patients,85 were negative for HER-2 before NAC,76 cases remained negative after NAC,5 cases(4%)were positive from negative to positive.There were38 cases with positive HER-2 status before NAC,including 19 cases who remained positive after NAC,8 cases(6%)who changed from positive to negative,9 cases of uncertain state of HER-2 before NAC.There were 37 cases in Ki-67 stable group and 22 cases in the Ki-67 increase group,71 cases(55%)showed decreased state of Ki-67.2.COX regression analysisThe tumor sizes before NAC,the lymph node status after NAC and the increase of Ki-67 after NAC were the independent risk factors for DFS.Only the tumor size before NAC was an independent risk factor affecting OS.Conclusion:1.The status of ER,PR,HER-2 and Ki-67 of the breast cancer are changed in different degrees between pre-and post-neoadjuvant chemotherapy.2.The increase of Ki-67 is an independent risk factor for DFS,but the increase of Ki-67 has no statistical significance to the effect of OS.3.The changes of ER and PR have no effect on the prognosis of breast cancer.