Analysis Of Prognostic Factors In Patients With Triple Negative Breast Cancer After Neoadjuvant Chemotherapy

Purpose:To explore the related factors affecting the prognosis of patients with triple Negative breast cancer after neoadjuvant chemotherapy,so as to better evaluate the prognosis.Methods:A retrospective analysis was conducted on 90 patients with primary early triple-negative breast cancer who received neoadjuvant chemotherapy and then surgical treatment in the Department of Breast Surgery of the First Hospital of Jilin University from November 2011 to July 2017.The clinicopathological data and survival of the patients were collected.Statistical analysis was performed using SPSS 26.0software.The chi-square test was used to analyze the relationship between clinicopathological characteristics and pathological evaluation of TNBC patients.Univariate analysis was performed using Kaplan-Meier method and survival curves were plotted.Multivariate analysis was performed using Cox proportional risk model to evaluate the independent risk factors affecting the prognosis of disease-free Survival(DFS)and Overall Survival(OS).P<0.05 was considered to be statistically significant.Results:A total of 89 TNBC patients received surgical treatment after neoadjuvant chemotherapy.Chi-square test analysis showed that TNBC patients with T2 stage,preoperative high expression of Ki67 and decreased expression of Ki67 after NAC were associated with higher Pathologic complete respons(PCR),and the comparison results among all groups showed statistically significant differences(all P<0.05).Kaplan-Meier univariate prognostic analysis and survival curve results showed that earlier preoperative N stage of axillary lymph nodes and TNM stage,PCR attainment after NAC,and decreased Ki-67 expression were associated with better DFS and OS,with statistically significant differences(all P<0.05).Cox multivariate prognostic analysis showed that axillary lymph node N stage,tumor TNM stage,PCR attainment and Ki67 expression were independent influencing factors of DFS risk(all P<0.05).TNM stage,PCR attainment and Ki67 expression were independent risk factors affecting OS(all P <0.05).N2 stage tumors had an increased risk of recurrence and metastasis(HR=3.742,95%CI1.694-10.787).Patients with TNM stage 3 had an increased risk of recurrence(HR=9.976,95%CI 1.510-19.216)and death(HR=7.816,95%CI 1.613-17.367).The risk of tumor recurrence(HR=30.937,95%CI1.844-107.511)and death(HR=31.765,95%CI 1.216-120.288)were increased in patients who did not achieve PCR.Ki67 expression changed with the risk of tumor recurrence in the undecreased group(no change:HR=2.314,95%CI 1.854-11.298;Increased expression: HR=22.311,95%CI 4.176-76.881)and risk of death(no change:HR=1.235,95%CI1.994-10.529;Increased expression: HR=20.156,95%CI 5.146-78.869).Conclusion:The tumor stage of T2,the high expression of Ki-67 and the decreased expression of Ki67 before surgery were related to the efficacy of NAC,and N stage,TNM stage,PCR and Ki67 expression after NAC were correlated with DFS of TNBC patients after NAC.Higher p CR rate was obtained.TNM stage,PCR after NAC and Ki67 expression were correlated with OS in TNBC patients after NAC.