The Investigation Of Normalization Therapy For Triple Negative Breast Cancer

Objective: The current therapy methods for treating triple negative breastcancer (TNBC) mainly include operation, chemotherapy, radiation therapy,molecular targeted therapy,etc. But due to its special pathology characteristicand biological behavior, the prognostics of patients with same pathologicaltype and therapy methods will vary. Carried out many researches on theprognostics of patients with TNBC, scholars throughout the world believeindexes that influence the prognosis of TNBC include tumor size, the amountof transferred lymph nodes, the clinical stage and the expression of P53. Thisstudy will provide a better guidance to clinical practice by further analysis ofthe factors affect the prognosis of TNBC.National Comprehensive Cancer Network (NCCN) is an Authoritativeacademic organization which is composed of the United States19world-classcancer center. One of declaratory guides which Associated with the breastcancer is 《NCCN breast cancer clinical practice guidelines》. Research foundthat the prognosis of patients with TNBC is worse than other types and nostandard treatment plan has been established by now. a2006-2011edition ofthe breast cancer clinical practice guidelines (Chinese edition) has formulatedand issued by our country breast cancer experts combined with China'sspecific condition. The guide makes a detailed introduction for breast cancerdiagnosis and treatment, and provided the basis of breast cancer diagnosis andtreatment to clinical physicians.This research discusses present treatment situation under the guidance fortriple negative breast cancer patients through analyzing the standardizationdegree of TNBC treatment retrospectively since the establishment of2006-2010edition of the breast cancer clinical practice guidelines (Chineseedition). This will provide a basis to the individualized treatment options of triple negative breast cancer patients, which improves the prognosis and lifequality of the patients.Methods: This research has selected2007hospitalized patients' data withprimary breast cancer in the medical oncology department and the center ofthe mammary gland of Fourth Hospital of He bei Medical University fromJanuary2006to November2010.these data have specific histologic diagnosisor cytology By molecular biology subtype expression of PR,ER and HER-2,these patients are divided into two groups,triple negative group and non-triplenegative group. The differences of breast cancer clinical and pathologicalfeatures and relapse and metastasis between the two groups are compared150cases of TNBC patients with adjuvant treatment, which fit the chemotherapycondition and neat chemotherapy of the2006-2010cNCCN breast cancerclinical practice guidelines for each year, are divided into two groups standardgroup and non-standard group.This research were analyzed retrospectively its curative effect. observedthe chemotherapy for distribution and the survival condition. We establisheddatabase for the clinical records of the patients and made continuous diagnoseby sending letters and seeking court which ended on Nov.30.2011.For thisphase, the operation time is used as the starting point and the end point can bedecided as the death of the patient, lost in contact or the last time of diagnose.During this time the patients that are alive or lost in contact are processed withtruncation values (lost in contact with truncation value of the end timefollow-up time). Patients died of TNBC related diseases are used as completedata. The search assigned value to the patients' clinical data that includes9determinants (age, tumor size, pathological types, histological grade, vasculartumor emboli, adjuvant radiation therapy, axillary lymph node metastasis,classification and dangerous clinical stage) which might affect the prognosticof TNBC patients. The date were calculated and analyzed by the Coxproportional hazard model which found out the independent factors thataffected the prognostic of TNBC patients (The variables that P <0.05inunivariate analysis was brought into multivariate COX proportional hazard model analysis). This paper retrospectively analyzed the2007patients withbreast cancer, including TNBC group of271cases, non-TNBC group of1736cases. Chi-square test was used for enumeration data comparison,Kaplan—Meier was used for survival ratio analysis. All tests were performedat the0.05level of significances.Results:1According to the2006-2010each years cNCCN breast cancer guidelines,The coincidence rate of our TNBC adjuvant chemotherapy which fit all theterms including drug, dose, intervals, course of treatment was respectively40%,36%,47%,50%,42%from the each year2006to2010.2According to the2006-2010each years cNCCN breast cancer guidelines,the coincidence rate of our TNBC adjuvant chemotherapy course of treatmentof the AC/EC scheme,(AC-T/D, EC-T/D) scheme, CAF scheme, FECscheme were71%,18%,45%,30%respectively.3The total dose of a single drug that is same combination chemotherapyregimen of our hospital in a cycle reduce10%-20%,which is compare toguides. The total dose for the treatment of our hospital same ChemotherapyRegimen is Fairly low in parts of chemotherapy dose.4The difference of the cyclophosphamide dose with a single drug in thecombination Chemotherapy Regime is more larger. The total dose of one cycleabout cyclophosphamide of our hospital CAF in2010increased approximately0.638g than the guide request under the body surface area (1.62/m~2). Thetotal dose of a cycle about cyclophosphamide in the EC program decreasedapproximately0.545g than the guide require.5Compared with the standard scheme of each year of the2006-2010cNCCN breast cancer guidelines, the average DFS of standard group on theanthracycline-based was34.369month, non-standard group was31.397month,two groups had difference in statistics (P=0.029). but The group of patientswhose OS have no obvious difference (P=0.094). Standard group andnon-standard group of Taxane were not statistically significant in PFS and OS(P=0.939,P=0.069). 6Compared with the standard scheme of2006-2010years cNCCN breastcancer guidelines, the average DFS of standardize group of the positive nodes(AC/EC, CAF scheme) was29.539month, the average DFS of Taxane were37.403month. two groups had difference in statistics (P=0.034) and the OSslightly differences,(P=0.047).(AC/EC, CAF) scheme of survival rateswith each year (1,2,3) were97.4%,67.9%,52.7%.The Taxane were96.3%,82.7%,61.5%. Lymph node negative have no statistical significance InPFS and OS (P=0.662, P=0.237). Tumor diameter>5cm (AC/EC, CAFscheme) to standardize the group and taxane standard group was notstatistically significant In PFS and OS (P=0.742, P=0.633). Tumor diameterless than5cmwere not obvious difference In PFS and OS (P=0.692, P=0.184).7The proportion of qualified of radiotherapy patients in accordance withthe demand of guidelines was81.2%,standard and no-standard group in PFSand OS were not significant differences.(P=0.129,P=0.273).8TNBC group of271cases accounted for13.5%of2007breast cancercases. Compared with the non-TNBC, TNBC was more common in womenafter the age of50(P <0.05). Difference existed in tumor size, pathologicaltypes, histologic classification, armpit lymph node metastasis and the clinicalstages, P53, ki-67expression state between TNBC and non-TNBC (P <0.05).9The transfer rate of TNBC recurrence and distant metastasis rate ofTNBC were higher than non-TNBC(P <0.05).10The univariate analysis showed that the prognosis of TNBC patientswas related to the primary tumor size and the lymph node metastasis.Multivariate analysis showed that lymph node metastasis and primary tumorssize are independent factors that would affect the prognosis of TNBC.Conclusion:1Triple negative breast cancer of this group accounted for13.5%of breastcancer.2The proportion of qualified of chemotherapy patients in accordance withthe demand of guidelines was43%and the radiotherapy was81.2%. 3Compared with the guidelines, the difference of the cyclophosphamidedose with a single drug in the combination Chemotherapy Regime. The totaldose for the treatment of our hospital same Chemotherapy Regimen is Fairlylow in parts of chemotherapy dose.4The standard group of the anthracycline-based (2006~2010each year)can prolong progression-free survival.5The patients of our TNBC with lymph node positive,Standard group ofTaxane (2006～2010years) can prolong progression-free survival and overallsurvive.6Compared with the non-TNBC, Difference existed in invasive age,tumor size, pathological types, histologic classification, armpit lymph nodemetastasis and the clinical stages, P53, ki-67expression state between TNBCand non-TNBC.7Compared with the non-TNBC, the rate of axillary lymph nodemetastasis, relapse and distant metastasis of TNBC is higher.8The lymph node metastasis and the diameter of primary tumors wereindependent factors that would affect the prognosis of TNBC.