Analysis Of Influencing Factors And Efficacy Prediction Of Neoadjuvant Chemotherapy On HR Positive And HER2 Negative Breast Cancer

Objective: Breast cancer is a highly heterogeneous tumor,and the sensitivity of different molecular types to chemotherapy is different.The main treatment for locally advanced breast cancer is Neoadjuvant chemotherapy,but patients with hormone receptor positive breast cancer are insensitive to neoadjuvant chemotherapy,the possibility of ineffective chemotherapy to progressive disease and loss of surgical opportunity is greater.Patients with locally advanced hormone receptor positive / human epidermal growth factor receptor 2 negative(HR+/HER2-)who can not keep breast but have strong desire to receive breast conserving surgery or with large mass difficult to cut need to consider neoadjuvant chemotherapy to achieve the purpose of descent stage.This study aimed to discuss neoadjuvant chemotherapy effect and influencing factors on HR positive and HER2 negative breast cancer and analyze its efficacy prediction value,to provide a reference for clinical doctors to make individualized treatment decisions for breast cancer patients.Method: Retrospective analysis,collect the clinical and pathological data of131 HR positive and HER2 negative breast cancer patients with NAC admitted to the breast surgery in the Affiliated Hospital of Southwest Medical University from 2015 to 2019.According to the RECIST1.1 version of evaluation criteria for solid tumor,the effect of chemotherapy include progressive disease(PD),stable disease(SD),partial response(PR),complete response(CR).In this study,the evaluation of clinical efficacy of patients based on the MRI results,the patients who achieved CR or PR after NAC were assigned into effective group,while those with SD or PD into ineffective group.Using rank sum test and χ~2 test to analysis of the relationship between different age,histological grade,tumor size,lymph node status,ER、PR、Ki-67 expression,chemotherapy regimen and chemotherapy cycle and efficacy.Analysis of the influencing factors of effect by dichotomous logistic regression,and by using the receiver operating characteristic(ROC)curve to evaluate the predictive value of each influencing factor,and calculate the best truncation value of the relevant factors,the lastly,by using the kappa test to analysis the correlation between Miller-Payne classification and RECIST classification.Results: The rate of complete pathological remission(p CR)was 3.6% in 131 NAC patients,The effective rate was 63.4%,Single factor analysis shows,Age,menstrual status,BMI,histological grade,tumor size,lymph node status and chemotherapy regimen were not statistically significant(P>0.05);ER(z=5.258,P<0.001)、PR(z=3.416,P<0.001)、Ki-67(z=5.424,P<0.001)chemotherapy cycle(z=6.234,P<0.001)as the influencing factors of effect;Multivariate analysis showed,ER、Ki-67、 the chemotherapy cycle as an independent factor of efficacy,ER as an independent risk factor,The cut-off value is65%(sensitivity of 91.7%,specificity of 55.4%),the area under ROC curve is0.774;Ki-67 high expression,multiple chemotherapy cycles as an independent protective factor,The cut-off values are 22.5%(sensitivity of 83.3%,specificity of 67.5%)and 6 cycles(sensitivity of 81.3%,specificity of 72.3%),the area under ROC curve is 0.78,0.821 respectively;The consistency between Miller-Payne classification and RECIST classification is poor(kappa=0.335,P<0.01).Conclusion: The pCR of NAC for HR positive and HER2 negative breast cancer is low,and ER、Ki-67、chemotherapy cycle are independent influencing factors of curative effect,if ER≥65%,Ki-67≤22.5%,chemotherapy cycle less than 6,neoadjuvant chemotherapy maybe less effective.The consistency between Miller-Payne grade and RECIST grade after neoadjuvant chemotherapy is poor.