Studies On The Effect Of Neoadjuvant Chemotherapy On ER,PR,Her-2 And Ki-67 In Premenopausal Breast Cancer

Objective: Currently,breast cancer has become one of the most common malignant tumors in women in China,accounting for about 7-10% of female malignant tumors.Menopausal breast cancer patients is rising year by year,but the clinical discovery already premenopausal breast cancer with Neoadjuvant chemotherapy,Neoadjuvant chemotherapy,NAC)is more easy to occur in the process of drug resistance and even the phenomenon of disease progression,showed a tumor on premenopausal breast cancer is a highly heterogeneous,but now is lack of effective prediction model used to guide clinical premenopausal breast cancer patients after Neoadjuvant therapy consultation.Currently,the interpretation of the efficacy of neoadjuvant chemotherapy is mainly based on the pathological results of the samples after chemotherapy,but this result cannot effectively reflect the tumor load before the first diagnosis of NAC and the objective response of tumor tissues to neoadjuvant therapy.Some studies have shown that the changes of ER,PR,her-2 and ki-67 are correlated with the efficacy of breast cancer NAC,but this theory lacks evidence-based evidence in the population of premenopausal breast cancer patients.In this study,the changes of ER,PR,her-2 and ki-67 in premenopausal breast cancer patients before and after NAC were analyzed to explore: 1)the influence of premenopausal breast cancer NAC on ER,PR,her-2 and ki-67;2)the relationship between the immunological markers with varying significance and the pathological evaluation of patients,so as to provide a theoretical basis for the prediction of the efficacy of premenopausal breast cancer patients and the formulation of postoperative programs.Methods:collected in January 2018 to June 2019 in the first hospital affiliated to China university of science and technology of west line breast clinic NAC and existence of residual tumor surgery was performed on 79 patients,the puncture before chemotherapy and postoperative tumor specimens were obtained both photochemical examination,according to effectively control to evaluate whether patients with disease patient response to chemotherapy.To analyze the expression changes of ER,PR,her-2and ki-67 before and after NAC and the correlation between the indicators with varying significance and the disease control rate of patients.Results:1.Participants included 79 patients with tumor residues of premenopausal breast cancer patients,age distribution in the 27-53,with an average age of 43 years old,has a history of nursing 75 cases(94.94%),11 cases(13.5%),type IIA and IIB phase of 39 cases(48.1%),stage IIIA 19 cases(23.4%),stage IIIB 4 cases(4.9%),stage IIIC 8 cases(9.8%)and ER(+)in 57 cases(72.15%)and ER(-)in 22 cases(27.85%),PR(+)in 31 cases(39.24%),There were 48(60.76%)patients with PR(-),21(26.58%)patients with her-2(+),58(73.42%)patients with her-2(-),67(84.81%)patients with ki-67(>)and 12(15.19%)patients with ki-67<14%.No distant metastasis occurred in all patients during NAC.2.Premenopausal patients after NAC,ER changed from positive to negative after NAC for 4 cases,negative into a positive(3 cases),PR after NAC changed from positive to negative in 5 cases,10 cases of negative into a positive,its her-2 after the NAC changed from positive to negative for 2 cases,negative into a positive in 2 cases,Ki-67 expression into after NAC from high to low expression for 23 cases,lower expression into high expression of 8 cases.Chi-square test of paired four-bar table showed that thechanges of PR(P=0.0299)and ki-67(P=0.0346)were significantly different,while the changes of ER(P=0.5573)and her-2(P=0.3053)were not statistically significant.3.The results of multivariate analysis before and after NAC in menopausal breast cancer patients showed that the positive or negative change from negative to positive after PR positive chemotherapy and the decreased expression level of ki-67 were independent predictors of the clinical disease control rate of breast cancer NAC(P < 0.01).ER and her-2 have not been proved to be associated with the efficacy of NAC in breast cancer.Conclusion: NAC can change the expression of PR and ki-67 in premenopausal breast cancer patients.After NAC,patients with positive PR without change or from negative to positive were significantly correlated with better efficacy.The effect of NAC in premenopausal breast cancer patients with decreased ki-67 expression level was more effective than that of those with increased ki-67 expression level.NAC can benefit PR positive patients(Luminal type)by inhibiting ovarian function.