Clinical Efficacy Of GnRHa Combined With Neoadjuvant Chemotherapy In The Treatment Of Premenopausal Breast Cancer

Objective:This study aims to investigate the correlation between the efficacy of gonadotropin-releasing hormone agonist(GnRHa)combined with neoadjuvant chemotherapy and neoadjuvant therapy(NAC)in patients with premenopausal breast cancer,and to observe the tumor reaction and histopathological reaction after treatment.Methods:The relevant information of premenopausal breast cancer patients who received neoadjuvant chemotherapy and completed surgery in the Breast Surgery Department of the Second Hospital of Jilin University from October 2021 to October 2022 was retrospectively collected,including patient age,imaging results of chemotherapy evaluation,adverse reactions during chemotherapy,preoperative puncture and postoperative pathological results and immunohistochemical results(including ER,PR and HER2).Imaging results during chemotherapy and pathological results after treatment were used as efficacy indicators.SPSS software was used for statistical analysis.For continuous factors and categorical factors,independent t-test was used to analyze the differences between different experimental groups,and paired t-test was used to analyze the differences before and after treatment in each group.Data that did not meet the requirements of the chi-square test were analyzed by continuous correction and Fisher’s exact method.logistic regression analysis was used to analyze the statistically significant differences.Wilcoxon rank sum test was used to analyze the tumor response after treatment,and P<0.05 was considered statistically significant.Results:1.The ORR of GnRHa combined with NAC group was 95.0%(n=20),and that of simple NAC group was 80.0%(n=60).Statistical analysis showed that there was no significant difference in ORR rate between the two groups(P = 0.115).2.After neoadjuvant therapy,the tumor size of the two groups was significantly reduced,and the change of tumor size in GnRHa combined with NAC group was more obvious than that in NAC group(p<0.05).In the chemotherapy group,the tumor size of patients with high expression of Ki67 was more significant than that of patients with low expression of Ki67(p<0.05).3.After neoadjuvant therapy,the level of Ki67 in both groups decreased significantly(p>0.05),and the change of Ki67 level in patients with high expression of Ki67 was more significant than that in patients with low expression of Ki67 in both groups(p<0.05).4.There was no significant difference(p>0.05)in postoperative pathological MP grade between the two groups.In the chemotherapy-only group,the patients with high expression of Ki67 had a higher MP grade(p<0.05)and a stronger histopathological response than those with low expression of Ki67.5.The pCR rate of GnRHa combined with NAC group was 25.0%(= 5/20),and that of simple NAC group was 21.7%(= 13/60).Statistical analysis showed that there was no significant difference in pCR rate between the two groups(p > 0.05).The pCR rate after neoadjuvant therapy was related to the level of estrogen receptor(ER)and the level of proliferative index(Ki67),and the level of ER was an independent factor affecting the rate of pCR(OR=0.132,95%Cl,0.034-0.502).Conclusions:1.There was no significant difference in ORR between the GnRHa combined with NAC regimen and the NAC regimen alone.2.There was a statistical difference in the percentage of tumor reduction between the two groups after treatment,which has a certain significance for the descending stage of breast cancer and reducing the scope of operation.3.According to the analysis of tumor shrinkage ratio,Ki67 proliferation index change and MP grade,patients with higher Ki67 level(>30%)are more sensitive to NAT,and patients with lower Ki67 level have poor response.4.The pCR rate after neoadjuvant therapy is related to the level of estrogen receptor(ER)and proliferation index(Ki67),and the level of ER is an independent influencing factor of pCR rate,and the patients with lower ER value have higher pCR rate.