| ??Objectives:Based on neoadjuvant chemotherapy data of human breast cancer,re-evaluation of neoadjuvant chemotherapy for human breast cancer from clinical pathological changes,clinical efficacy and prognosis,and provide evidence for clinical application of neoadjuvant chemotherapy for breast cancer.??Research content1.Summarize the common pathological changes after neoadjuvant chemotherapy of breast invasive ductal carcinoma,analyze its relationship with efficacy and prognosis of neoadjuwant chemotherapy.2.Quantitative analyse nucleus morphological parameters of tumor cells before and after neoadjuvant chemotherapyofbreast invasive ductal carcinoma,and analyse its relationship with efficacy of neoadjuvant chemotherapy.3.Explore the relationship between clinical response or pathological response with prognosis of neoadjuvant chemotherapyofbreast invasive ductal carcinoma.4.Compare the prognosis between neoadjuvant chemotherapy and adjuvant chemotherapyofbreast invasive ductal carcinoma.5.Explore and analyze the relationship between clinical pathological factors(age,tumor size,chemotherapy regimen,histological grade,lymph node metastasis)with efficacy and prognosis of neoadjuvant chemotherapyofbreast invasive ductal carcinoma.6.Explore the relationship between ER,PR,HER2,Ki-67,CDK8,molecular subtypes with the efficacy and prognosis of neoadjuvant chemotherapyofbreast invasive ductal carcinoma.??Method:1.A total of 158 cases of neoadjuvant chemotherapy for of breast invasive ductal carcinoma were collected from Southern Hospital of Southern Medical University from April 2013 to December 2018.The clinical and pathological evaluation criteria of chemotherapy efficacy were used to evaluate the efficacy of patients.The pathological changes of breast cancer before and after neoadjuvant chemotherapy were observed.A total of 210 cases of adjuvant chemotherapy after radical mastectomy were collected from January 2012 to December 2015.Collect the informations of patient's clinical pathological information and survival status,analyze the efficacy and prognosis of neoadjuvant chemotherapy.2.The image analysis software was used to measure the tumor nucleus morphological parameters.and analyze its relationship with efficacy and prognosis of neoadjuvant chemotherapy.3.The expression of ER,PR,HER2 and Ki-67 before neoadjuvant chemotherapy were detected by immunohistochemistry.Semi-quantitative scoring was performed.Analyze the relationship between ER,PR,HER2 and Ki-67,molecular subtypes with efficacy and prognosis of neoadjuvant chemotherapy.4.A total of 138 patients who diagnosed as invasive ductal carcinoma from Southern Hospital of Southern Medical University from April 2017 to September 2018 were enrolledfor CDK8 immunohistochemistry.Analyze the correlation with CDK8 and ER,PR,HER2,Ki-67 and the efficacy of neoadjuvant chemotherapy.??Result:(?)Clinical pathological analysis of the efficacy and prognosis of neoadjuvant chemotherapy for human breast invasive ductal carcinoma1.Compared the pathological changes before and aftert neoadjuvant chemotherapy,we can concluded that it can be showed as cytoplasmic eosinophilic or vacuolation,giant cells in the tumor parenchyma,foam-like tissue cells in tumor stroma and terminal duct-lobular unit atrophy in normal breast tissues.All of the above features suggest that the efficacy of neoadjuvant chemotherapy is better.Survival analysis showed that cytoplasmicvacuolationor terminal ductal-lobular unit atrophy predicted a higher progression-free survival rate and a better prognosis.2.Measure the nuclear morphological parameters of tumor cells before neoadjuvant chemotherapy,the smaller of the nuclear long axis,nuclear short axis,nuclear perimeter,nuclear area,nuclear regular form factor of the cancer cells are more likely achieve pCR/near-pCR.3.Compare the nuclear morphological parameters of cancer cells before and after neoadjuvant chemotherapy for breast invasive ductal carcinoma.About 78%of cases,the nuclear long axis,nuclear short axis,nuclear perimeter and nuclear area were larger than those before chemotherapy,suggesting that the nucleus is bigger after neoadjuvant chemotherapy.About 81%of cases,the nuclear regular form factor was smaller than that before chemotherapy,suggesting that the nucleus is close to a circle or an ellipse after neoadjuvant chemotherapy.4.Patients with clinical remission have higher progression-free survival rate than those without clinical remission,the lymph node metastasis rate was lower.There was no difference in clinical remission with age,tumor size,histological grade,chemotherapy regimen,and AJCC stage.5.In the Miller-Payne grading standard,the survival rate of grade 1 is lower than that of grades 3,4,and 5.The survival rate of grade 2 is lower than that of grade 5,and there is no significant difference between the other grades.Patients with near-complete or complete pathologic response had higher progression-free survival rate,while patients with mild or no pathologic response had lower progression-free survival rate.6.Based on taxanes,the progression-free survival rate of neoadjuvant chemotherapy was lower than that of adjuvant chemotherapy.There was no difference in survival rate between neoadjuvant chemotherapy and adjuvant chemotherapy in patients who receive anthracycline and taxane therapy.(?)Analysis of the factors affecting the efficacy and prognosis of neoadjuvant chemotherapy for human breast invasive ductal carcinoma1.The pCR/near-pCR was significantly different from tumor size,chemotherapy regimen,histological grade and lymph node metastasis,and there was no difference in age.That patients with tumor size<5cm or histological grade ? are more likely to achieve pCR/near-pCR,and patients with pCR/near-pCR have a lower lymph node metastasis rate.Patients with Taxane and Platinum treatment are more likely to achieve pCR/near-pCR,followed by Taxane and Platinum with trastuzumab,Gemcitabine and capecitabine,and finally taxanes and anthracyclines.2.Univariate and multivariate analysis,patients with tumor stage T1-T2 or achieve pCR/near-pCR had higher progression-free survival rate and better prognosis;There was no significant difference between age,chemotherapy regimen,lymph node metastasis,histological grade with progression-free survival.3.The expression of CDK8 was negatively correlated with the expression of ER and PR,and there was no difference withhe expression of HER2,Ki-67,molecular subtypes,age,tumor size,lymph node metastasis and AJCC stage.Low expression of CDK8 is more likely to achieve pCR/near-pCR;4.Patients with ER negative or PR negative or HER2 positive are more likely to achieve pCR/near-pCR.In molecular subtypes,HER2 over-expression is more likely to reach pCR/near-pCR,followed by triple negative breast cancer,and finally hormone receptor positive(Luminal A/B type).5.PR negative is easier to achieve clinical remission.In molecular typing,triple negative breast cancer is more likely to achieve clinical remission,followed by HER2 overexpression and finally hormone receptor positive(Luminal A/B).6.Survival analysis showed that the expression of ER,PR,HER2,Ki-67 and molecular subtypes were not significantly different from the progression-free survival rate in neoadjuvant chemotherapy.??Conclusion:1.Neoadjuvant chemotherapy can change the nucleus morphology.Most of the tumor cells have a bigger nuclear morphology and the nucleus is close to a circle or an ellipse.The tumor cells with cytoplasmic eosinophilic or vacuolationor the appearance of giant cells,interstitial foam-like tissue cell infiltration or TDLU atrophy suggests a better efficacy of neoadjuvant cnemotherapy.Survival analysis showed that cytoplasmicvacuolation in tumor cells or the appearance of terminal ductal-lobular unit atrophy predicted a higher progression-free survival rate and a better prognosis.2.Tumor size,histological grade,chemotherapy regimen,nuclear morphology and expression of CDK8,ER,PR,Her-2,and molecular subtypes are closely related to the efficacy of neoadjuvant chemotherapy.(1)Tumor size<5 cm or histological grade III or patients treated with taxane and platinum have a better efficacy of neoadjuwant chemotherapy.(2)the smaller of the nuclear long axis,nuclear short axis,nuclear perimeter,nuclear area,nuclear regular form factor of the cancer cells are more likely achieve pCR/near-pCR.(3)low expression of CDK8 is more likely to achieve pCR/near-pCR,suggesting better efficacyof neoadjuvant chemotherapy.(4)ER negative or PR negative or HER2 positive suggest better efficacy of neoadjuvant chemotherapy.(5)Among the molecular subtypes,HER2 over-expression and triple-negative breast cancer are more effective than hormone receptor-expressing.3.Tumor size and pathological remission are closely related to the prognosis of neoadjuvant chemotherapy.Patients who with tumor size<5cm,or reached pCR/near-pCR have a higher progression-free survival rate and better prognosis.4.Imaging suggests that patients with maximal diameter reduction of tumors greater than 30%after neoadjuvant chemotherapy have higherprogression-free survival rate and better prognosis,and the lymph node metastasis rate is lower.5.Based on taxanes,the progression-free survival rate of neoadjuvant chemotherapy was lower than that of adjuvant chemotherapy in patients.There was no difference in survival rate between neoadjuvant chemotherapy and adjuvant chemotherapy in patients who receive anthracycline and taxane therapy. |
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