| Objective:By studying the expression of Ki67 before and after neoadjuvant chemotherapy of TNBC,we conduct the clinical curative effect and prognosis of survival relation analysis to discuss the existence of curative effect in TNBC after neoadjuvant therapy and the clinical significance of changes in value to discuss TNBC which associated with breast cancer clinical factors about changes of Ki67 and to evaluate new curative effect about neoadjuvant chemotherapy and the relationship between the long-term prognosis.Methods:The clinical data of 115 patients with TNBC treated with neoadjuvant chemotherapy from 2012 to 2019 in the first affiliated hospital of Chongqing Medical University were retrospectively analyzed.According to the changes before and after the Ki67 expression can be divided into expression decreased in group A and group B,which the expression is not decreased,using X~2 test to two groups,respectively,and the status,age,tumor stage,preoperative Ki67 expression after NAC treatment after pCR,NAC tumor load factors such as statistical analysis,the related factors of pCR line chi-square analysis,and then use the K-M survival curve,the long-term survival results of ROC Curve prediction,and COX regression model of risk assessment on the presence of significant risk factors related to prognosis.Results:The median age of 115 cases of triple negative breast cancer was 49,TNM staging inⅡperiod accounted for the highest(69.60%),preoperative high Ki67 expression(83.50%),tumor size,local regional lymph node staging is much less than T2 and N2.Median follow-up was 18months,the total recurrence and metastasis rate was 16.16%,13.33%in group A and 29.10%in group B.X~2 test analysis showed that Ki67 in group A was more prone to high expression before surgery(X~2=3.869,P<0.05).The effective ratio of group A was 78.30%,and that of group B(SD+PD)was 52.72%,which was significantly correlated with the change of Ki67(P<0.05),and there was a significant difference between the two groups(P<0.05).The overall pCR rate was 62.61%,but no statistical significance was found between the two groups(P>0.05).COX proportional regression model showed that Ki67 variation was an independent risk factor for DFS(HR=3.156,95%CI:1.339-7.438,P<0.05),and the risk of recurrence and metastasis increased in the non-descending group,especially within 3-5 years after diagnosis.It can also be considered that the change of Ki67 is a factor affecting the long-term OS risk(HR=3.235,95%CI:0.994~10.529,P=0.051),and the risk of death is increased in the non-decreasing group.Kaplan-Meier survival curve showed that the Ki67 decreasing group was associated with better DFS and OS,and the difference was statistically significant(P<0.05).The cut-off value of Ki67 change value after NAC was calculated by the Jorden index was 36.5%,the effective sensitivity of NAC was 20.5%,and the specificity was 100%.Conclusion:The group without Ki67 decline is more likely to have increased lesions after neoadjuvant chemotherapy(clinical evaluation of tumor progression).Ki67 changes have certain predictability for the evaluation of NAC tumor load in triple negative breast cancer,which can be used as one of the reference indexes for the efficacy of TNBC neoadjuvant chemotherapy.The earlier the preoperative N stage of axillary lymph node and the TNM stage of the tumor were,the greater the possibility of obtaining pCR after NAC was.However,there was no effect of the choice of neoadjuvant therapy and the change of Ki67 expression on pCR.For the included population,the Ki67 fluctuation range≥36.5%confirmed that the clinical invalidation after NAC had certain auxiliary predictability,which was of certain value for the patients who failed to complete the evaluation after neoadjuvant treatment and better guided the postoperative adjuvant chemotherapy process of different populations.At the same time,it further provides evidence for the adjustment of postoperative adjuvant drugs and the addition of oral chemotherapy drugs such as capecitabine in some high-risk groups.However,due to the small sample size and many unknown potential influencing factors in the stage of neoadjuvant therapy,it is necessary to further control data migration,improve the overall prediction ability by combining other indicators,and verify by a large number of prospective studies.The Ki67 descending group was more likely to have a higher survival benefit.In addition,changes in Ki67 to some extent can predict recurrence and metastasis,while Ki67 not descending group can increase the risk of tumor recurrence and metastasis by about 3 times to some extent,especially the need for rigorous follow-up and intervention when necessary within 3-5 years after diagnosis.However,pCR has not been found to translate into a long-term survival advantage in patients with TNBC.Considering many factors affecting OS,preoperative Ki67 expression and pCR alone could not accurately predict long-term recurrence and metastasis risk and overall survival outcome. |
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