| Background Neoadjuvant chemotherapy (NAC) has been widely accepted as the standard management of breast cance in recent years. Neoadjuvant chemotherapy of breast cancer can not only improve the surgery resection rate, but also increase the probability of breast-conserving srugery.And for patients who gained pathologic complete response (pCR) after neoadjuvant chemotherapy may have improved long term survival. It is very important to improve the efficacy of neoadjuvant in the treatment of locally advanced breast cancer and identify the reliable predictive markers for the response of neoadjuvant chemotherapy. This will greatly help to make individual treatment scheme in the management of breast cancer.Objective To compare and analysis the effect and side effect of two neoadjuvant chemotherapy regimens (TE and TEC).To evaluate the changes in biological molecular (ER, PR, HER-2 and Ki-67) before and after neoadjuvant chemotherapy and investigate the influence of NAC on molecular markers. The other objective of this analysis was to assess the possible relationship between biological factors and curative effect of NAC.Methods The data of 63 female patients with Stageâ…¡a,â…¡b andâ…¢a breast cancer was retrospectively analyzed. These patients with average age 47 were enrolled into the department of thyroid and breast surgery, the No.1 affiliated hospital of Anhui Medical University from January 2006 to January 2011. All patients with non-metastasis tumors were received neoadjuvant chemotherapy with two to four cycles of TE or TEC regimen before operation. Karnofsky score is more than 80. All tumors were identified by core needle biopsy before neoadjuvant chemotherapy. Response rate was evaluated after neoadjuvant chemotherapy and the RR,CR,pCR and breast-conserving rate were analyzed with the help of SPSS FOR WINDOWS 16.0. Biological molecular markers(ER,PR and Ki-67)determinations were performed by immunohistochemistry in pre-neoadjuvant core biopsies tissues and final surgical specimens. Changes of markers expression were evaluated after neoadjuvant chemotherapy. The reason of changes induced by neoadjuvant chemotherapy and their correlations with tumor response were analyzed.Results Among all the 63 patients with operable breast cancer, 32 patients with breast cancer received TE regimen before operation, the rate of RR was 84.4% (27/32), CR was 46.9% (15/32), pCR was 15.6%(5/32), breast-conserving therapy was 12.5% (4/32). 31 patients received TEC regimen, the rate of RR, CR, pCR, breast-conserving therapy was 87.1% (27/31), 51.6% (16/31), 22.6% (7/31), 12.9% (4/31) respectively. In the differences of the clinical response rate between TE and TEC regimen, there were no significant differences (P>0.05). The side effect between them is similar, which mainly conclude nausea and vomiting, leucopenia and alopecia. The difference of Ki-67 before and after primary chemotherapy was significant (P=0.005). There were significant correlations between changes of Ki-67 expression and clinical response (P<0.05).Conclusions The effect of the two neoadjuvant chemotherapy regimens (TE and TEC) are similar. The bone marrow suppression of TE regimen is less seriously. It is recommended to utilized widespreadly in clinic. Neoadjuvant chemotherapy induced variations of markers (ER,PR,HER-2,Ki-67) expression in patients with breast cancer. The investigating results have shown that the changes of Ki-67 expression may be related to tumor response, and could be used to predict the sensitivity of treatment. |
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