| Background: As the breast cancer gradually replaces lung cancer to be the malady with the worst rate in the world,it becomes more and more important to improve breast cancer screening and optimize auxiliary treatment schemes in clinical work.IDC-NST is the most common subtype in breast cancers.How to improve the diagnosis and treatment of breast cancer and its prognosis has become the focus of clinical research.NAT refers to the treatment of systemic chemotherapy,endocrine therapy,molecular targeted therapy and immunotherapy before doing therapy(surgery or radiotherapy)at localized regions of non-metastatic malignant tumors.Its purpose is to shrink the primary site,reduce metastatic lymph nodes,enhance the long-term survival rate of patients,and improve the quality of survival.Different from supplementary therapy performed in the past,NAT specifically refers to the treatment of systemic drugs before surgery.With the use of NAT,patients who suffer from the diseases with high recurrence rates,such as triple negative breast cancer and HER-2 positive breast cancer can effectively improve their survival rate and long-term prognosis.At present,NAT has been widely used in the comprehensive treatment of breast cancer in our country,and the efficacy evaluation of NAT before surgery is important for the prognosis evaluation of patients.The overall shape and the changes in three-dimensional volume after the application of NAT are called tumor shrinkage.Tumor regression grade(TRG)is widely used to evaluate pathological reactions after NCT.There are many TRGs proposed for breast cancer,such as Miller-Payne(MP)system,Residual Cancer Burden(RCB)system,Sataloff system,etc.There are differences between these evaluation systems.Due to the error of the quality of the material specimen and the interpretations of the results,the various studies also have different results.Internationally,it has not determined a unified evaluation standard,and it is still controversial whether it is an independent prognosis factor.Therefore,it is of great significance for the comparative research between different TRG systems.Objective: Discuss postoperative pathological characteristics between different tumor retreat grading standards and IDC-NST which use NAT,and compare their prognostic prediction value.Methods: A total of 150 patients with breast IDC-NST who underwent NAT at the First Affiliated Hospital of Dalian Medical University between January 2018 and October 2022 were collected.Clinical information(including MP system grading)was collected from the start of treatment to the last follow-up or the occurrence of endpoint events(complete pathological response or death).RCB system and Sataloff system were used to evaluate each patient’s grading.It was set into three subgroups: MP group,RCB group and Sataloff group.The patients’ age,tumor site,NAT scheme,preoperative molecular phenotype,preoperative clinical T stage,postoperative SBR grade,clinical efficacy evaluation,lymph node metastasis,vascular invasion,and nerve invasion were respectively compared.SPSS26.0 software was used to statistically analyze the differences in various indicators between groups.Cox univariate and multivariate regression analyses were used to explore prognostic factors.Survival curve was drawn by Kaplan-Meier analysis.Receiver operating characteristic(ROC)curves of MP,RCB and Sataloff grading were plotted using R language 4.1.1 software to compare the prognostic value of different grading criteria.Results:1.MP is divided into five tiers.MP grading was correlated with whether HER-2was positive before NAT.Patients with HER-2 positive type had higher MP grading,with statistical difference(P<0.05).The higher the MP grade,the better the postoperative clinical efficacy evaluation,the difference is statistically significant(P<0.01).MP grading is significantly correlated with the SBR.The higher the MP,the lower the SBR,and the difference between the groups is statistically significant(P<0.01).MP classification is significantly related to T staging.The higher the MP,the lower the T-stages,and the difference is statistically significant(P<0.01).Among the 150 patients,83 cases of lymph nodes were metastasized,accounting for 55.3%,of which,MP1 and MP2 transfer were 51 cases,accounting for 61.4%.The lower the MP,the higher the transfer rate.The result is statistically significant(P<0.01).There are 49 vascular violations,of which MP2 vascular violations were the most,up to 20 cases(40.8%),followed by 19 cases(40.0%)in MP1.The lower the MP,the higher the vascular invasion rate,and the MP grading and the vascular violation have significant differences(P<0.01).There are 21 cases nerve infiltration,MP1-3 accounted for 100%,with significant differences(P<0.01).2.RCB is divided into 4 tiers.In RCB grading,the higher the RCB grade,the worse the postoperative clinical efficacy evaluation,the difference is statistically significant(P<0.01).The RCB classification is significantly correlated with the SBR tissue.The higher the RCB,the higher the SBR organizational grading,and the comparison between the groups is statistically significant(P<0.01).The size of the tumor in each grade of RCB is significantly different.The higher the RCB,the higher the T-stages,and the result is statistically significant(P<0.01).The lymph node metastasis rate of RCB-III patients is as high as 73.0%(27 cases),while the rate of RCB-0 has only17.9%(5 cases).The higher the RCB,the higher the lymph node transfer rate.(P<0.01).The RCB grading has a significant correlation with the vascular violation.The higher the RCB,the higher proportion of vascular violations.There is a significant difference in RCB grading and vascular invasion(P<0.01).The correlation between RCB grading and neural violations is significant.There are 10 cases(27.0%)of neural violations in RCB-III,while RCB-0 has no neural violations.And the comparison is statistically significant(P=0.01).3.Sataloff is divided into 4 tiers.In Sataloff grading,the Sataloff has a significant correlation with the SBR tissue grading.The higher the Sataloff,the higher the SBR tissue grading.The comparison between the groups is statistically significant(P<0.01).The higher the grade of Sataloff,the worse the evaluation of postoperative clinical efficacy,the difference is statistically significant(P<0.01).The Sataloff grading is significantly related to T stages.T stages of T-A are all T1 or T2,while there are only 6cases of T-D reaches to T4 stage(60.0%).The higher the Sataloff,the higher the T stages.The difference is statistically significant(P<0.01).The higher the Sataloff,the higher the lymph node metastasis.And there are statistical differences(P<0.01).Sataloff grading has a significant correlation with vascular violations.The higher the Sataloff,the more vascular violations(P<0.01).The results showed that MP,RCB,and Sataloff system evaluation groups were not related in age,tumor site,NAT scheme,etc.So the differences were not statistically significant(P> 0.05).There is no correlation between the grading of RCB and Sataloff and the HER-2 positive type before NAT(P> 0.05).Sataloff grading has no significant correlation with neural violations(P=0.052).4.All patients draw a survival curve according to MP,RCB,and Sataloff.Kaplan-Meier shows that in the MP group,the higher the MP grading,the longer the patient’s overall survival(OS).OS at different levels has statistical differences(P=0.032);in the RCB,the lower the RCB grading,the longer the patient’s OS.OS at different levels has statistical differences(P=0.040);in the Sataloff,there is no statistical difference between various grades(P=0.082).5.Use single and multi-factor Cox proportional risk regression model to calculate hazard ratio and 95% CI,and explore the prognosis of TRG and clinical features related to OS.Analysis results of the single variable:(1)Sataloff hierarchical T-D risk of death is significantly higher than T-A(HR 10.935,95%CI 1.135-105.366).There are statistical differences(P<0.05);(2)The T4 stage death risk of TNM is significantly higher than the T1 stage(HR 4.140,95%CI 1.032-16.610),and there are statistical differences(P<0.05);(3)The risk ratio of the deathless infiltration is significantly less than the nerve infiltration(HR 0.288,95%CI 0.108-0.768),and the nerve infiltration is significantly related to OS(P<0.05);(4)The risk of death in the combination treatment group is less than the simple chemotherapy(HR 0.371,95%CI 0.140-0.980),and there are statistical differences(P<0.05).An analysis of the Cox regression including other P<0.2 factors and multi-factor the treatment plan and neurological violations show that the death risk ratio of other treatment groups is still smaller than the simple neo-assisted chemotherapy(HR 0.987,95%CI 0.352-0.125).There are statistical differences(P=0.047)and it is independent risk factor for prognosis of NAT patients(P value is close to the critical value).6.ROC curves of survival state after NAT were drawn according to the MP,RCB and Sataloff evaluation groups.The Area under curve(AUC)of breast IDC-NST patients predicted by MP,RCB and Sataloff were 0.714,0.720 and 0.690.Conclusion:1.The MP criteria,RCB criteria and Sataloff criteria in tumor regression grading have certain predictive value for the prognosis of breast IDC-NST patients receiving NAT,and the RCB standard has the best predictive efficacy.The higher MP grade,the longer OS;The higher the RCB grade,the shorter OS.2.MP,RCB and Sataloff are correlated with clinical efficacy evaluation,SBR grading,lymph node metastasis rate,vascular invasion rate and nerve invasion rate.In patients with low MP grade after surgery,clinical efficacy evaluation is worse,SBR grade is higher,and the rate of lymph node metastasis,vascular invasion and nerve invasion is higher.Patients with high RCB grade after surgery have good clinical efficacy,high grade of SBR,high rate of lymph node metastasis,vascular invasion and nerve invasion.Patients with high grade of Sataloff after surgery have good clinical efficacy,high histological grade of SBR,high rate of lymph node metastasis and vascular invasion. |
