| Objective: Analyze the expression of CK5/6 and EGFR before and after neoadjuvant chemotherapy in triple negative breast cancer and their correlation with chemotherapy efficacy and clinical prognosis.Methods:(1)We retrospectively collected all the clinical materials of 195 patients identified as TNBC who accepted neoadjuvant chemotherapy in Tianjin Medical University Cancer Institute and Hospital from June 2014 to June 2018.Elimination of late(phase IV)cases of ER,PR,HER-2 status changes due to chemotherapy and non-operability.(2)Chooses cases of invasive non-specific carcinoma diagnosed by histology.(3)All patients treated radical mastectomy,modified radical mastectomy or mastectomy(breast conserving)as the primary surgical treatment regimen.(4)Chemotherapy regimen: All patients underwent chemotherapy with an anthracycline combination or sequential yew regimen with a total cycle of 6～8.Then,the expression levels of CK5/6 and EGFR before and after NAC were detected respectively,and we analyzed the relationship between the expressions changes of the two biomakers before and after chemotherapyand and the efficacy and prognosis.Results: The median follow-up time was 30 months,24.1% of TNBC patients received NAC during follow-up(47/195)had recurrence or metastasis,5.1%(10/195)had death,the median disease-free survival(DFS)was 29 months,and the median overall survival(OS)was 30 months.According to the definition of our study,TNBC was classified as basal-like breast cancer(BLBC)and non-basal like breast cancer(NBLBC),with 89.7% and 10.3% respectively before chemotherapy.And the clinicopathological variables of the two groups before NAC were compared,the results showed no significant difference among the these variables.And patients who achieved clinical overall remission rate(ORR)is about 86.2% and pathological complete remission rate(p CR)is 29.2%,however there was no significant difference in p CR rate between the two groups of BLBC and NBLBC(P=0.661).Univariate and multivariate logistic regression analysis showed that clinical tumor size(c T)staging was an independent influence factor for chemotherapy efficacy(P<0.05).Meanwhile,it was confirmed that the changes of CK5/6 and EGFR were statisticallydifferent before and after NAC.The prognosis of TNBC patients was further analyzed.Multivariate Cox regression analysis showed that p CR(P=0.006),NAC chemotherapy effect(P=0.023),neoadjuvant tumor stage(yp T)(P=0.009),neoadjuvant lymph node metastasis(yp N)(P=0.001),histological grade(P=0.016)and after-NAC CK5/6expression(P=0.041)significantly affected prognosis.The changes of CK5/6 and EGFR before and after NAC were divided into four groups respectively: positive to negative group,negative to positive group,negative to negative group and positive to positive group.The results showed that the different changes of CK5/6 and EGFR before and after NAC were not statistically significant(P>0.05),but the DFS of CK5/6 and EGFR which positive to negative were higher than those of negative to positive group and positive to positive group(P=0.0814,0.0707).However,we were not analyzed the prognosis of the changes of basal-like and non-basal like groups because of the number of cases with recurrence or metastasis was rarely.Conclusion: For patients with locally advanced TNBC who received NAC,there was no statistically significant difference in p CR rates between BLBC and NBLBC.However,patients with TNBC had relatively better prognosis in patients achieved p CR.And the neoadjuvant chemotherapy did affect the expression of biomarkers in the patient,the changes of CK5/6 and EGFR from positive to negative in the patient after NAC had a tendency to improve the prognosis,but further validation of a large number of TNBC studies was needed. |
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