Analysis Of Efficacy And Prognostic Of Neoadjuvant Chemotherapy For Locally Advanced Breast Cancer Of Different Molecular Subtypes

Objective:To analyze the efficacy and prognosis of neoadjuvant chemotherapy for locally advanced breast cancer of different molecular subtypes,and to explore its correlation.Methods:The clinicopathologic data of 232 patients with locally advanced breast cancer admitted to the Department of Breast Surgery,Chengde Medical University from January 2016 to June 2020 were retrospectively analyzed.102 patients who received neoadjuvant chemotherapy were used as the observation group,and 130 patients who did not receive neoadjuvant chemotherapy were used as the control group.The postoperative recovery,incidence of adverse reactions of chemotherapy,recurrence and metastasis rate and prognosis were compared between the two groups.The efficacy and prognosis of patients with different molecular subtypes of breast cancer in the observation group were compared alone.The related factors of efficacy and prognosis in the observation group were also analyzed.Results:1.There was no significant difference in postoperative recovery,incidence of adverse reactions of chemotherapy and recurrence and metastasis rate between the two groups(P > 0.05).The disease free survival rate and overall survival rate at 1 and 3 years were compared between the two groups,and there was no significant statistical difference(P > 0.05).2.According to the molecular subtypes,the observation group was divided into five subgroups,and there were no significant differences in the clinical efficacy and disease free survival and overall survival rates at 1 and 3years(P > 0.05).The pathological efficacy were compared,The rates of pCR with Luminal A type(7.7%),Luminal B/Her-2(-)type(7.7%),Luminal B/Her-2(+)type(26.1%),HER-2 positive type(36.8%),triple negative type(33.3%),respectively.There was significant difference between the groups(P<0.05).3.The related factors affecting pCR were analyzed,and there was no significant correlation between pCR and age,menstrual status,BMI,lymph node status,and clinical stage,and the difference was not statistically significant(P > 0.05).There was a significant difference in the pCR rate when the tumor size was analyzed(P < 0.05).There was no significant difference in the pCR rate of PR expression,HER-2 expression and Ki-67expression(P > 0.05),but there was significant difference in the pCR rate of ER expression(P < 0.05).4.The molecular subtype,tumor size,lymph node status and immunohistochemistry were not correlated with disease free survival rate and overall survival rate,and the difference was not statistically significant(P > 0.05).pCR and clinical stage were related to disease free survival,both of which were statistically significant(P < 0.05).No significant statistical significance was observed between pCR,clinical stage and overall survival rate(P > 0.05).There were correlations between OPP and disease free survival and overall survival,which were statistically significant(P < 0.05).Conclusion:1.Compared with postoperative adjuvant chemotherapy,neoadjuvant chemotherapy did not affect the postoperative recovery,incidence of adverse reactions and survival of patients with locally advanced breast cancer,demonstrating that the efficacy of neoadjuvant chemotherapy is safe and reliable.2.Molecular subtypes are closely related to pCR.Patients with HER-2positive type and triple negative breast cancer have a higher pCR rate,and have a similar prognosis to luminal type after neoadjuvant chemotherapy.3.pCR was also associated with tumor size and ER expression,and it was considered that the pCR rate was higher when the tumor was smaller and ER was negative.4.pCR,OPP,and clinical stage are closely related to the disease free survival rate of patients.For neoadjuvant chemotherapy to predict the overall survival rate of patients,OPP can be used as a predictor.