Study On The Improvement Of Neo-bioscore Evaluation System By Incorporating PCR State After Neoadjuvant Chemotherapy

Background:Breast cancer is the most common malignant tumor in women in China.Its incidence is increasing year by year,which seriously endangers women's physical and mental health.Breast cancer is highly heterogeneous.Different histological types and molecular types lead to different clinical manifestations,treatment sensitivity and prognosis.With the increase of patients with locally advanced breast cancer and the emergence of a large amount of breast-conserving intentions,neoadjuvant chemotherapy has become a bridge connecting long-term survival with female aesthetics.The purpose of neoadjuvant chemotherapy is to reduce primary tumor and eliminate lymph nodes with metastatic cancer,which reduces tumor staging and grading.Thus NAC makes patients with inoperable huge mass operable,and increase breast-conserving rate.With neoadjuvant chemotherapy,in vivo drug sensitivity of primary tumor can be observed,making it possible to select effective regime.Therefore,it is particularly important to evaluate the efficacy of neoadjuvant chemotherapy.Currently,the Neo-Bioscore evaluation system contains almost all of the tumor-related biological indicators of breast cancer.It appears to be the most accurate evaluation system by far.The scores are given to predict survival outcomes after neoadjuvant chemotherapy so that a well-established treatment plan can be developed.There are many studies in China designed to verify if the Neo-Bioscore evaluation system is equally applicable to our patients,and the answer is positive.In recent years,a large number of clinical trials on the prognosis of neoadjuvant chemotherapy have shown that,patients who achieved PCR after neo-adjuvant chemotherapy had a prolonged survival,comparing to those who did not.Therefore PCR has become the most notably prognostic indicator.This study aims to improve the accuracy of Neo-Bioscore evaluation system through adding the factor of PCR.Methods:Enroll patients who underwent breast surgery after receiving neoadjuvant chemotherapy in the Second Hospital of Jilin University from January 2015 to December 2018.Collect general clinical data of patients,neoadjuvant chemotherapy regime,postoperative pathology,and follow-up information.The new Neo-Bioscore scoring system adding PCR is call the ReNeo-Bioscore system,assuming a score of 0 for patients who achieved PCR and 1 for patients who failed to achieve PCR.Calculate score with each system,then compare the impact of the original Neo-Bioscore system on disease-free survival to that of the ReNeo-Bioscore system.Analyze the data with statistic methods to compare the accuracy of the two evaluation systems.1.The Neo-Bioscore scores were calculated from 141 patients enrolled,and the relationship with DFS was analyzed to verify whether the Neo-Bioscore system is suitable for the Chinese population.2.The Neo-Bioscore score and ReNeo-Bioscore scores of the enrolled patients were calculated,and the relationship with DFS were analyzed.The AUC of each ROC curve of the two systems were calculated to compare whether the addition of PCR factor made the evaluation system more accurate.3.Of the 141 patients,49 had Luminal A&B breast cancer,54 had HER-2 over-expressed breast cancer,and 38 had triple negative breast cancer.The scores were calculated by the Neo-Bioscore system and the ReNeo-Bioscore system.The two systems were compared in different molecular type subgroup to see whether it shows a difference in accuracy.Result:A total of 166 patients were enrolled,median age is 50(26-68)years,median follow-up time is 20(1 to 48)months.141 patients were followed up and 25 patients were lost to follow-up.The rate of loss of follow-up was 15%.1.The Neo-Bioscore score of 141 patients was calculated and the correlation between the score and DFS was analyzed.The results show that the Neo-Bioscore assessment system is meaningful for the risk assessment of DFS and is applicable to patients in China.2.In recent years,many clinical trials of neoadjuvant chemotherapy have suggested that whether PCR is achieved after neoadjuvant chemotherapy has an impact on the prognosis of patients,so we boldly assume that adding factor of PCR to the Neo-Bioscore evaluation system(we call it the ReNeo-Bioscore evaluation system)can improve the accuracy of its risk assessment.We calculated the Neo-Bioscore score and the ReNeo-Bioscore score of 141 patients,and plotted the KM curve.We found no significant difference between the KM plots.By drawing the roc curve,the best dividing points of neo-bioscore score and reneo-bioscore score are 3 points and 4 points,respectively.We performed stratified analysis according to LuminaA&B subgroup,Her-2 overexpression subgroup and TNBC Sub-group.Analysis of Her-2 overexpression subgroup showed that there was a significant difference between the ReNeo-Bioscore score and the Neo-Bioscore score.Then the ROC curve of the two scores of the Her-2 overexpression group was drawn.ReNeo-Bioscore was found to be more sensitive after the addition of PCR in the Her-2 overexpression group.Conclusion:1.The study found that by comparing the Neo-Bioscore score with DFS in 141 patients in our hospital,the Neo-Bioscore score can be used as a predictor of DFS in our hospital after neoadjuvant chemotherapy.2.The use of PCR as a prognostic indicator in the Neo-Bioscore evaluation system did not improve its predictive sensitivity.However,in the stratified analysis,the ReNeo-Bioscore system was superior to the Neo-Bioscore system in the Her-2 overexpression group,demonstrating whether PCR is achieved is an important prognostic indicator in the subgroup of Her-2 over-expressing type.