The Effect Of Coagulation Factors On Neoadjuvant Chemotherapy In Breast Cancer

Background: Neoadjuvant chemotherapy(NAC)has played an important role in the comprehensive treatment system of breast cancer;NAC is used to convert unresectable to resectable cancers,to increase the rate of success for tumor resection and breast-conserving surgery and to evaluate the response to chemotherapy regimens before surgery.A series of studies have suggested an association between the hemostatic system and tumor biology.Recently,some studies have shown that coagulation factors are associated with the prognosis of breast cancer patients.However,there have been very few studies on the relationship between pretreatment coagulation factors and the response to NAC in breast cancer patients.The present study was aimed to evaluate the correlation between pretreatment coagulation factors(fibrinogen(Fib),prothrombin time(PT),prothrombin time ratio(PTR),international normalized ratio(INR),activated partial thromboplastin time(APTT),prothrombin activity(PTA),thrombin time(TT),fibrinogen degradation product(FDP),and D-dimer(DD))and the response to NAC in breast cancer patients.Methods: This retrospective study included 1035 patients whoconfirmed invasive breast cancer by histology and received NAC.Medical records were reviewed to collect pretreatment clinical data,such as age,sex,tumor size,lymph node status,hormonal status,the status of human epidermal growth factor receptor 2(HER2)receptor,the index of Ki67,and coagulation factors.All data were analyzed using SPSS(version 25.0)software(SPSS Inc.,Chicago,IL,USA).The univariate and multivariate analyses were performed for the variables to see the relationship of the ratios to pCR.Results: The median value of Fib,rather than other plasma coagulation parameters,was clearly increased in pCR patients compared with non-pCR patients(P = 0.008).pCR to NAC was correlated with preteatment tumor size(P < 0.001),lymph node involvement status(P <0.001),clinical tumor stage(P < 0.001),ER status(P < 0.001),PR status(P< 0.001),HER2 status(P = 0.028),Ki67 index(P < 0.001),molecular subtype(P < 0.001),and Fib status(P = 0.003).Adjusted for tumor size,lymph node involvement,PR status,and Ki67 status in the multivariate logistic regression model,low Fib status was strongly associated with pCR to NAC(OR = 2.436,95% CI = 1.419-4.180,P = 0.001).Conclusion: This study demonstrates that low pretreatment plasma Fib is an independent predictive factor for pCR to NAC in breast cancer patients.