| Background Breast cancer is a heterogeneous disease.It is divided into different subtypes by hormone receptor and human epidermal growth factor receptor 2(HER-2)gene.Each subtype has different tumor biological characteristics,therapeutic effects and prognosis.Clinically,patients with early-stage breast cancer with hormone receptor-positive,HER-2-negative,and node-negative breast cancer have a good prognosis.In addition to clinical pathological features such as tumor size,tissue grade,Ki-67 index,and lymphatic metastasis,they are common prognostic references.The index,21 gene recurrence risk test can provide additional prognostic information,and has been widely used in clinical practice.The predictive value of 21 gene detection has been verified in several breast cancer 21 gene recurrence risk detection studies,while the 21 gene recurrence risk score has been evaluated.The factors affecting the prognosis of early breast cancer patients are not enough in China.Object Oncotype Dx RS is a gene expression-based assay commonly used to predict the prognosis of patients with early breast cancer.In this study,we investigated the effects of tumor size,age at diagnosis,tumor tissue typing,surgical procedures,chemotherapy,radiotherapy,and endocrine therapy on the prognosis of breast cancer patients with early breast cancer risk scores,in order to improve their understanding and guidance.Clinical treatment to improve the prognosis of patients.Method A total of 141 patients with breast cancer who were admitted to the Henan Provincial People's Hospital for breast cancer 21 gene testing from December 2014 to June 2018 were included in the study.All patients were female.Inclusion criteria:(1)pathological diagnosis of primary breast cancer,and postoperative stage is 0-stage II;(2)in accordance with the surgical indication plan to implement surgical treatment;(3)immunohistochemistry suggests estrogen or pregnancy Hormone receptor-positive patients;(4)immunohistochemistry suggests HER-2 negative,or immunohistochemistry suggests that HER-2 is suspected positive by fluorescence in situ hybridization(FISH)detection suggesting HER-2 negative;(5)lymph node metastasis Negative;(6)Sequential adjuvant therapy based on the US National Comprehensive Cancer Network Guidelines(NCCN);exclusion criteria:(1)Immunohistochemistry suggested that HER-2 expression was negative;(2)Immunohistochemistry suggested that HER-2 was suspected positive and fluorescence-in situ hybridization(FISH)detected HER-2 receptor-positive;(3)Exclusion of previous breast Tumor history and other primary tumors;(4)distant metastasis;(5)any adjuvant therapy before surgery.The clinical and pathological data of the patients were collected and analyzed.All patients underwent surgery.The tumor pathology,tumor pathological grade,Ki-67 index and other clinicopathological features were compared between the two groups.Chemotherapy,radiotherapy and endocrine therapy and recurrence-free survival(Recurrence free)Survival,RFS)prognosis.Statistical analysis was performed using EXCEL2010 and SPSS20.0 software.The comparison between groups was expressed as a percentage,using X2 or Fisher's exact test.The prognosis was performed by Kaplan-Meier survival analysis and COX proportional hazard model with 95% confidence interval(CI).One-way and multi-factor analysis were used to evaluate the prognosis of patients with RFS.The survival curve was drawn by Kaplan-Meier method.If the statistical value P value was <0.05,the difference was considered statistically significant.Result(1)A total of 141 patients' medical history data were collected and analyzed.All patients were female.They were divided into two groups according to RS,including 94 patients with low recurrence risk(66.6%)and 47 patients with moderate-high recurrence risk(33.4%).).(2)In the RFS-related study of breast cancer patients with low recurrence risk group of 21 genes,single factor analysis showed that patients with poor RFS and menstrual status(HR=0.020;95% CI 0.477-1.396;P=0.035),postoperative order Percent chemotherapy(HR=0.090;95% CI 0.015-0.540;P<0.001)and KI-67 status(HR=0.017;95% CI 0.696-2.922;P=0.029)were associated with no premenopausal patients at diagnosis.Recurrence and metastasis survival time was lower than postmenopausal patients at diagnosis;patients with KI-67?14% had no recurrence and metastasis survival rate less than KI-67 <14% patients;patients with sequential chemotherapy after surgery had low recurrence-free survival Patients who did not receive sequential chemotherapy after surgery;however,after adjustment for other variables,analysis by multivariate analysis found only postoperative sequential chemotherapy(HR=0.146;95% CI0.024-0.877;P=0.035)and poor RFS Significantly correlated,and in the subgroup RS0-10 group,RS11-18 group prognosis analysis showed no significant difference between the two groups(Log Rank P = 0.281)(3)Among the 21 cases of high-grade breast cancer patients with clinical case characteristics and RFS correlation,single factor analysis showed tumor size(HR=0.097;95% CI 0.009-1.075;P=0.018),tumor pathological grade(P =0.013)and KI-67 status(HR=0.010;95% CI 0.016-4.955;P=0.041)were associated with poorer RFS in patients,in which the recurrence-free survival of patients with tumor size ? 2 cm was lower than the diagnosis.Patients with tumor size <2 cm;patients with tumor pathological grade III had lower recurrence and metastasis survival than patients with tumor pathological grade I and II;patients with KI-67 ? 14% had a recurrence-free survival of less than KI-67 <14%.After adjusting for other variables,multivariate analysis showed that tumor size,KI-67 status,and histopathological grade were not associated with the prognosis of RFS in the middle-high group(P>0.05).Conclusion(1)The poor prognosis of breast cancer patients with low recurrence risk group was significantly associated with menstrual status,postoperative chemotherapy and KI-67 status.Postoperative sequential chemotherapy was an important factor affecting prognosis,but its prognosis The extent of the impact was not significantly related to the level of RS.(2)Tumor size,tumor pathological grade and KI-67 status of 21 patients with high-grade breast cancer were associated with poor prognosis of patients,and there was no significant independent influence factor. |
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