Analysis Of Prognostic Factors In Breast Cancer Patients With Non-pathological Complete Response After Neo-adjuvant Chemotherapy

Objective: to explore the prognostic factors for the breast cancer patients with nonpathological complete response after neoadjuvant chemotherapy,and evaluated their impacts on prognosis.Methods:Retrospectively analyzed of the clinical outcomes and pathological information of 461 patients with nonpathological complete response(non-p CR)after neoadjuvant chemotherapy at the Breast Center of the Fourth Hospital of Hebei Medical University from January 2010 to January 2015.Used the univarable factor analysis to screen the one that had an impact on the prognosis,the level α<0.1,used the prognostic factors that met the standards to make the multvarable COX proportional hazard regression model,P<0.05,The survival curves were drawn by Kaplan-Meier and tested by log-rank test,P<0.05.Results: the median age was 48(21-76)years,and the median follow-up time was 91 months.it was found that age,number of lymph node metastases,vascular involvement around the tumor,and molecular typing were related factors that affected the prognosis of non-PCR patients after neoadjuvant chemotherapy.The DFS of 8.1 years for those aged >35 years and ≤35 years were 92.2% and 40.9%(P=0.000);The DFS of the post-operative pathological lymph node metastasis ≤3 compared with >3 at 8.1 years was 93.6% and 74.6%(P=0.000);The patients with non-invasion of blood vessels compared to PVI was 94.4% and 71.8%(P=0.000)at 8.1 year.The 8.1-year OS of patients aged >35 and ≤35 years were 94.6% and 45.5%(P=0.000);postoperative pathology showed that the number of lymph node metastases was ≤3 and >3 were 97.4% and 80.1%(P=0.000);the vascular non-invaded and invaded around the tumor were 97.7% and 78.0%(P=0.000).The DFS of the HER2+,the HER2+(HR+),the Triple negative type,the Luminal A and Luminal B at 8.1 years were: 71.1%,67.5%,50.%,95.2%,88.3%(P=0.000).The difference was statistically significant with Luminal A being the best and Triple negative type being the worst.Pairwise comparison results showed: the Luminal A was better than the Luminal B;the Luminal B was better than the HER2 +;the HER2 was better than the HER2+(HR+);the HER2+(HR+)was better than the Triple negative type(P<0.05).The OS of the HER2+,the HER2+(HR+),the the Triple negative type,the Luminal A and Luminal B at 8.1 years were: 73.7%,71.4%,65.8%,97.2%,92.0%(P=0.000).The difference was statistically significant,with Luminal A being the best.It also showed that the Luminal A is better than Luminal B and the Luminal B was better than the HER2+ and the HER2+ was better than the HER2+(HR+)and the HER2+(HR+)is better than the Triple negative type,there were statistically significant differences(P<0.05).Conclusions:1.Age,number of lymph node metastases,vascular involvement around the tumor,and molecular typing were related for the prognosis of non-PCR patients after neo-adjuvant chemotherapy for breast cancer;2.Aged≤35 years,positive lymph nodes>3,PVI,Her2-positive and basic-like subtype were risk factors for the prognosis of non-PCR patients after neo-adjuvant chemotherapy for breast cancer.3.Among the 8.1-year DFS of patients with different molecular types,the Luminal type A was the best,reaching 95.2%,and the Triple negative type was the worst,only 50.0%.4.Among the 8.1-year DFS of patients with different molecular types,the Luminal type A was the best,reaching 97.9%,and the Triple negative type was the worst,only 68.4%.