| Objective in this retrospective study,by analyzing clinical efficacy and safety of TE(with epirubicin and Paclitaxel or docetaxel)of neoadjuvant chemotherapy in breast cancer patients in Tibetan population at high altitude were investigated.analyzing the related factors affecting the clinical remission of breast cancer.Hoping to provide more clinical reference for the follow-up treatment of breast cancer.Methods Selectioned 48 advanced breast cancer patients with IIb-IIIc from January 1,2008 to October 30,2017,in the Oncology Department of the people’s Hospital of the Tibet Autonomous regio,and With neoadjuvant chemotherapy(NAC).All patients were pathologically comfirmed as breast cancer and had immunohistochemistry.All patients received two-six cycles of TE neoadjuvant chemotherapy befor surgeiy.and all patients followed up completely after the evaluation of the efficacy and toxicity of the neoadjuvant chemotherapy,Completed the prescribed treatment.RECIST criteria was used to evaluate the clinical efficacy,Using X2 test or fisher accurate test to analyze the comparison between the positive rate in the counting data;the binary Logistic regression analysis was used to analyze the dependent variables of ERP by single factor;and the rank sum test was used to analyze the rank data.Result 1.All patients were evaluated with epirubicin and taxus with neoadjuvant chemotherapy for 2 cycles.The responses rate(RR)was62.5%(30/48),of which 42.1%(8/19)in the HR(+)/HER-2(-)group,80.0%(4/5)in the HR(-)/HER-2(+)group,57.1%(4/7)HR(+)/HER-2(+)group and 82.6%(14/17)HR(-)/HER-2(-)group,which was significantly higher than that in the HR(-)group than HR(+),(P=0.017),In the HR(-)group.There was no sig-nificant difference in RR between HR(-)/ HER--2(+)group and HR(-)/ HE-R-2(-)group,(P>0.05).There was no significant difference in the clinical effective rate between the two groups(P>0.05).Unvariate analysis showed that the expression of ER,PR was related to the clnical effective solutionrate after neoadjuvant chemotherapy.Multivariate analysis showed that ER status was an independent factor affecting clinical effectiveness.Of all the study patients,27 received4-6 cycles of neoadjuvant the rapy,The results of single factor analysis showed that ER,PR expression was related to RR rate after neoadjuvant chemotherapy.Two factor regression analysis showed that ER status was an independent factor affecting RR rate.27 patients received 4-6 cycles of neoadjuvant therapy.The results of the 2 cycles vs.4 cycles were significantly different in the results between the two groups(p=0.032).2.Immunohistochemical examination was performed before and after operation.40/48 patients was performed with Ki-67,and clinical efficacy in 29 patients 72.5%(29/40),including 25 cases of high expression of Ki-67 62.5%(25/ 40),4 cases of low expression of Ki-6 7.10%(4/40),11 patients of clinical failure 27.5%(11/ 40),including 6 patients of high expression of Ki-67 15.0%(6/40).The expression of Ki-67 was low in 5cases12.5%(5/40),and there was a significant difference between the two groups(P<0.047).The expression of Ki-67 in most cases after NAC was significantly lower than that before,and the high expression of Ki-67 before chemotherapy accounted for mo-re than 77.5%(31/40).The overexpression of Ki-67 was significantly decreased in 52.5%(21/40)of the patients after.The expression of Ki-67 was compared before and after chemotherapy.The results showed that the difference was statistically significant(p=0.034).Major adverse reactions after chemotherapy,43(89.5%)cases of granulocytopenia,Among them,10 patients of grade Ⅲ,Ⅳ granulocytopenia were found to be 2case had(20.8%),and very severe erythrocte and thrombocytopenia were rare,only 1 case had(2.0%)granuloc ytopenia.Other side effects of chemotherapy included Ⅰ、Ⅱ、Ⅲ granulocytopenia vomiting(n=30,6 6.7%),lipsotrichia,all patients suffered from alopecia after chemotherapy.(n=48,100%),skeletal muscle pain,numbness(n =6,12.5%),liver dysfunction(n=5,10.4%).Allergic reaction(n= 3,6.3%),mucositis(n=4,8.3%),etc.Conclusion 1.the use of TE neoadjuvant chemotherapy in the Tibetan women’s breast cancer patients is more effective and can tolerate the adverse reactions,which can be used as the routine scheme for the NAC of the breast cancer of the Tibetan population.2.In Tibetan breast cancer,ER status and Ki-67 expression status are potential predictors of the efficacy of TE regimens. |
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