Effect Of Neoadjuvant Chemotherapy Combined With Surgical Treatment On Clinical Efficacy And Prognosis Of Locally Advanced Breast Cancer

Objective:To study the effect of neoadjuvant chemotherapy combined with surgery on locally advanced breast cancer,to explore the effect of neoadjuvant chemotherapy on intraoperative and postoperative conditions and the factors affecting the prognosis of locally advanced breast cancer patients.Methods:Retrospective analysis in January 2013 to January 2018 in the XXX hospital treated 124 cases of patients with locally advanced breast cancer,including 56 patients with neoadjuvant chemotherapy after surgery(Luminal A 7cases,Luminal B20 cases,Her-2+ 21 cases and triple negative 8 cases),There were 68 patients receiving adjuvant chemotherapy after direct surgery(Luminal A 6cases,Luminal B21 cases,Her-2+ 38 cases and triple negative 3 cases).Compared neoadjuvant chemotherapy group in various subtypes of breast cancer after neoadjuvant chemotherapy tumor pathology ease the situation,as well as the neoadjuvant chemotherapy group and chemotherapy after surgery patients in postoperative complications of postoperative recurrence metastasis rate of survival rate and so on,by using single factor and multiple factors Logistic regression model to analyze the curative effect of neoadjuvant chemotherapy factors affecting prognosis factors using Kaplan Meier method and COX regression model analysis the relevant factors affecting the prognosis of patients with locally advanced breast cancer.Results:Different molecular subtyping in the neoadjuvant chemotherapy group classification of breast cancer patients in the age,menopausal status tumor size clinical TNM staging pathological type and there was no statistically significant difference between NAC curative effect(P > 0.05),multiple factors analysis showed that ki67 expression level molecular classification NAC cycle were independent factors affecting the curative effect of NAC(P < 0.05)among them,the molecular classification and chemotherapy cycle is the effect of neoadjuvant chemotherapy for pathological ease completely independent factors(P < 0.05).In the neoadjuvant group and the control group,there was no significant difference between the two groups in the age of patients,the size of primary tumor,and the status of axillary lymph node,ki-67,clinical TNM staging,pathological tissue type,molecular subtype,histological classification,chemotherapy regimen and other results(P>,0.05).There was no significant difference between the two groups in postoperativecomplications of subcutaneous hydrops infection(P>,0.05).The amount of intraoperative blood loss in NAC group was significantly lower than that in control group,and the operation time was significantly shorter than that in control group(P<0.05).There was no significant difference in disease-free survival rate and overall survival rate between the two groups at 13 and 5 years of local recurrence and distant metastasis(P>,0.05).Cox regression model found that molecular classification of clinical TNM staging was an independent risk factor for overall survival of patients with locally advanced breast cancer,and the higher the clinical TNM staging,the higher the risk of death.The risk of death was higher in patients with the triple negative type than in patients with the lumina type.Conclusion: 1.Molecular types,ki-67 and chemotherapy cycle can be used as indicators to predict the efficacy of neoadjuvant chemotherapy for breast cancer and guide the comprehensive treatment of breast cancer.Compared with luminal subtype,HER2 overexpression and triple negative breast cancer have better short-term efficacy and are more suitable for neoadjuvant chemotherapy.The high expression of ki-67 was more sensitive to neoadjuvant chemotherapy than the low expression.For patients who are sensitive to neoadjuvant chemotherapy,the PCR of patients who have completed 6chemotherapy cycles is higher.If conditions permit,the neoadjuvant chemotherapy cycle should be appropriately increased.2.Neoadjuvant chemotherapy is safe and effective in the treatment of locally advanced breast cancer,which can shorten the operation time and reduce intraoperative bleeding without increasing the risk of recurrence,metastasis and death.3.Clinical TNM staging and molecular phenotype are independent factors affecting the long-term survival of locally advanced breast cancer patients,so early diagnosis is a key factor to improve the efficacy of locally advanced breast cancer.