Study Of The Relevance Between Breast Cancer Molecular Subtype And Tumor Shrinkage Model Following Neoadjuvant Chemotherapy

objective:Primary tumor lesions of breast cancer showing a differentretreat mode after received neoadjuvant chemotherapy.Primary tumor lesionsretreat mode is closely related to prognosis.Studying the relevance betweenbreast cancer molecular subtype and tumor shrinkage model followingneoadjuvant chemotherapy,Predicted primary tumor lesions retreat mode byusing molecular subtypes following neoadjuvant chemotherapy,in order topredict response to neoadjuvant chemotherapy, reduce the local recurrence rateand ensure negative margins of breast conserving surgery.Methods:(1)Collec-ted54cases of untreated stageⅡ～Ⅲlocally advanced breast cancerpatients treatment in the Affiliated Hospital of Luzhou MedicalCollege between October2011to October2012.(2)To improve therelevant examination: breast ultrasound, mammography examination, breastMRI, etc. Perform breast primary tumor hollow needle aspiration biopsy toclear histological type,grade and ER,PR,HER-2and Ki-67status.If foundpositive axillary lymph nodes, diagnose by lymph nodes fine needleaspiration.Marked the skin projection of the primary tumor boundary withmethylene blue.Combined with physical examination, mammography,ultrasound and MRI results to comprehensive assessment and measure theprimary tumor size.(3)After2-4cycles of chemotherapy cycles,evaluation theclinical curative effect.Do modified radical mastectomy for patients when tumor was significantly reduced for surgery, clinical complete remission orhave no progression.TAC chemotherapy:docetaxel75mg/m2, cyclophosphamide500mg/m2, pirarubicin50mg/m2, intravenous d1;21d as a course oftreatment.(4)Collection the samples in multi-site (up, down, left, right,shallow, at the base),multi-point (in the range of tumor regression perpoint spacing0.5cm) which line of six different directions in thepostoperative residual tumor.In order to evaluate the situation ofprimary tumor lesions retreating， do Histopathological examinationand immunohistochemical examination for each samples.(5)UsingEncision method of immunohistochemistry detect the ER,PR,Ki-67protein and HER-2gene of the breast cancer tissue.if theimmunohistochemical test results of HER-2gene is2+,detect theHER-2gene by fluorescence in situ hybridization(FISH) again.if theimmunohistochemical test results of HER-2gene is1+or3+,do notdetect again.(6)Cytology training the tumor tissue and detecting thedrug sensitivity of each chemotherapy drugs(docetaxel, paclitaxel,pirarubicin,epirubicin,cyclophosphamide,fluorouracil,methotrexate,doxorubicin) to derived the chemotherapy-Tumor growth inhibitioncurve.(7)Comparative analysis differences between the molecular subtypes indifferent tumor retreat model.Kaplan-Meier method was used to estimate therecurrence-free survival of two tumor retreat model.P<0.05was consideredstatistically significant.Results:1.Primary tumors which54cases of breast cancer patients into groups,are different degrees of retreat.And there a mainlytwo modes:24cases(44%) of Concentric based retreat mode,30cases(56%) ofNested-based retreat mode.17cases retreat ratio is less than50percent,37casesretreat ratio is greater than50percent,the differences between the two group ofprimary tumor retreat model have no statistically significant(X2=5.816，P>0.05).2.There are two cases (22.2%) of concentric based retreat mode andseven cases (77.8%) of nested-based retreat mode in Luminal A patients.Thereare three cases (14.3%%) of concentric based retreat mode and eighteen cases(85.7%) of nested-based retreat mode in Luminal B patients.There are eightcases (80%) of concentric based retreat mode and two cases (20%) ofnested-based retreat mode in HER-2over expression patients.There are elevencases (78.6%) of concentric based retreat mode and three cases (21.4%) ofnested-based retreat mode in basal-like patients.The differences between themolecular subtypes in two tumor retreat modes was statisticallysignificant(X2=21.259，P<0.05).3.Kaplan-Meier curve analysis:compared withthe concentric based retreat mode group,the recurrence-free survival was lowerthan the nested-based retreat mode group,and the difference was statisticallysignificant Kaplan-Meier（X2=7.25，P=0.007）.4.54cases patients with themost four sensitive chemotherapy drugs was docetaxel,Pirarubicin,paclitaxel,cyclophosphamide,the difference between the molecular subtypes in four groupof chemotherpay drugs was no significan（tX2=15.683,P=0.074）. Conclusions:1.Primary tumor lesions of breast cancer showing concentric based retreat mode and nested-based retreat mode which accepted neoadjuvantchemotherapy.mode-based nested retreat recurrence-free survival of breastcancer patients is less than concentric retreat mode based breast cancerpatients.nested-based retreat mode of breast cancer patients is not easy to getnegative margins in breast-conserving surgery and the prognosis ispoor.2.Molecular subtypes and tumor regression model are closely linked.HER-2over expression type and basal-like type have a higher sensitivity tochemotherapy,and will have higher PCR.HER-2over expression type andbasal-like type will showing concentric retreat mode than other types.moresuitable choice of breast-conserving surgery and minor surgical edge.luminalsubtypes of breast cancer patients on chemotherapy sensitivity better thanHER-2over expression type and basal-like type,and showed more nestedretreat mode than other typs.luminal subtypes of breast cancer patients are notsuitable choose breast-conserving surgery.3.Most breast cancer patients aresensitive to docetaxel, Pirarubicin, paclitaxel, cyclophosphamide,but differentmolecular subtypes did not differ significantly for differentchemosensitivity.Molecular subtypes and sensitivity of Chemotherapy drugs areno significant correlation...