| Objective:To investigate the differences curative effects of neoadjuvant chemotherapy(NAC)for different subtypes of Luminal B breast cancer and its prognosis,to compare the clinical characteristics of different subgroups,then to discuss the individualized treatment of Luminal B like breast cancer.Methods:A retrospective study of 316 cases of Luminal B like breast cancer patients who completed the projected NAC courses and surgical treatment in Department of Breast Surgery,the First Hospital of Jilin University from January 2011 to December2016.All the biopsy specimens before treatment were positive for estrogen receptor(ER).According to the expression of progesterone receptor(PR),Her-2 and Ki-67,316 cases of the Luminal B like breast cancer patients were divided into 3 subgroups.PR low expression subgroup,Her-2 negative and PR< 20% or negative,Ki-67 any levels;PR high expression subgroup,Her-2 negative,PR?20% and Ki-67 ?14%;Her-2 positive subgroup,Her-2 positive,Ki-67 and PR any levels.And 75 cases of Her-2 overexpression breast cancer patients who completed the projected NAC courses and surgical treatment in Department of Breast Surgery,the First Hospital of Jilin University from January at the same period were included in the study.The clinical pathological materials and follow-up recurrence events of the patients were collected,and compared the differences of clinical pathological characteristics,NAC efficacy and prognosis of 3 subgroups,then compared the differences of prognosis between her-2 positive group and her-2 overexpression breast cancer.Results:1.Among the three subtypes of Luminal B like breast cancer,there were no significant differences in the age,the size of primary tumor and the stage of TNM(P > 0.05).There were significant differences in the lymph node metastasis rate among three subgroups(P=0.003),and the lymph node metastasis rate was highest in PR low expression subgroup among three subgroups.2.There were no significant differences in the clinical response among three subgroups(P>0.05).but there were significant differences in the clinical response among three subgroups(P=0.007).8.9%(28/316)patients achieved the pathological complete response(pCR);the rate of pCR in each subgroup had statistically significant difference(P=0.007),the rate of pCR in Her-2 positive subgroup was the highest,and the rate of pCR in PR high expression subgroup was the lowest.3.The Log-Rank test of the survival curves of three subgroups had not statistically significant difference(P=0.092),but the 3-year disease-free survival(DFS)and 5-year DFS of the patients in PR high expression subgroup were slightly higher than those in other two groups.4.The DFS of the patients in Her-2 positive subgroup was longer than that of the Her-2 overexpression breast cancer at the same period,and the difference was statistically significant(P=0.036).5.Single factor analysis of cox model showed that primary tumor size and Her-2 status were significant factors affecting the DFS of Luminal B like breast cancer(p < 0.05).Multiple factor analysis showed that only primary tumor size was independent factor affecting the DFS of Luminal B like breast cancer(p < 0.05).Conclusion:1.The Luminal B like breast cancer patients who had Her-2 negative and PR low expression were more likely to occur lymph node metastasis.2.The Luminal B like breast cancer patients who had Her-2 positive were more sensitive to NAC and more likely to achieve pCR.3.There was no significant difference in prognosis among the 3subgroups of Luminal B like breast cancer,but the patients with her-2 negative and PR high expression had a trend of overall survival advantage,and there was a tendency of poor long-term survival in PR low expression patients.4.Luminal B/Her-2 positive breast cancer has a better prognosis than the her-2 overexpression breast cancer.5.Primary tumor size was an independent factor affecting the DFS of Luminal B like breast cancer. |
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