Effectiveness And Chemosensitivity Genes Of Adjuvant Chemotherapy In Patients Of Postoperative Breast Cancer With Positive Axillary Nodes

Objective: The efficacy and sensitive genes of chemotherapy with program ofepirubicin combined with cyclophosphamide sequential docetaxel (AC-D program)were studied in breast cancer patients with axillary lymph node metastasis, in order todefinite the effect and predicted genes of treatment with the program, which wouldprovide the evidence for selecting individualized programs among the method ofadjuvant chemotherapy after operation in patients with breast cancer.Methods: March2008-December2009,84cases, all of the breast cancer withaxillary lymph node metastasis postoperative the First Affiliated Hospital of DalianMedical University was treated by using the adjuvant chemotherapy with program ofepirubicin combined with cyclophosphamide sequential docetaxel (AC-D program).Common gene mutation related to the breast cancer was detected by adopting the IonTorrent sequencing technique of third-generation gene sequencing instrument. Theroutine postoperative follow-up was proformed to obtain the survival status of thepatients, and observe the3-year with disease-free survival (Disease free survival, DFS)and the efficacy of postoperative adjuvant chemotherapy with the AC-D programs tochoose the genes related to chemotherapy sensitivity.Results: The genes of PIK3CA、C-Met、C-Kit、MLH1、STK11and TP53weredetected to mutate among the84breast cancer patients with axillary lymph nodemetastasis. The patients with gene mutation of PIK3CA was40cases (47.6%).Throughstatistical analysis, PIK3CA was negatively related to the age of patients. The rate ofgene mutation of the patients between <50years and>50years was compared, and theresult was66.7%and37.0%respectively, and P=0.009, which had statisticallysignificant. The younger patients had the trend of gene mutation, which was positivelycorrelated with the clinical stage. The rate of gene mutation of the patients between II stage and III stage was compared, and the result was37.5%vs61.1%respectively, and P=0.027, which had statistically significant. The patients with advanced clinical stagehad the trend of gene mutation, which was related to the3-year DFS. The recurrencerate was22.5%in patients with gene mutation, and47.7%in patients without genemutation, P=0.016. It was considered that the gene PIK3CA was related to the efficacyof breast cancer with postoperative adjuvant chemotherapy, and the3-year DFS withgene mutation was superior to it without mutation, which had statistically significant.The gene PIK3CA was sensitive gene of postoperative auxiliary chemotherapy withAC-D program. The patients with gene mutation of C-MET was11cases (13.1%),which was not correlation with clinical features, including clinical stage, hormonereceptor, and whether or not lymph node metastasis. But it was correlation with the3-year DFS, the recurrence rate was72.7%in patients with gene mutation and30.1%inpatients without mutation, P=0.016.It was considered that the gene C-MET was relatedto the efficacy of breast cancer with postoperative adjuvant chemotherapy, and the3-year DFS without gene mutation was superior to it with mutation, which hadstatistically significant.The C-MET was resistance genes of postoperative adjuvantchemotherapy with AC-D program. The genes mutation of C-KIT、MLH1、STK11andTP53was not related to the efficacy of breast cancer with postoperative adjuvantchemotherapy. The gene mutation of TP53was positively bound up with T stage oftumor, the rate of gene mutation with the side of tumor≤2cm was12.9%and34.0%with the side of tumor＞2cm, P=0.034,which had statistically significant. The T stageof tumor was later in patients with gene mutation, and others genes was not correlationwith clinical characteristics, including clinical stage and whether or not lymph nodemetastasis.Conclusion:1. In this group of postoperative breast cancer patients, the rate of3-year DFS was35.7%, and the PIK3CA was associated with the3-year DFS. The3-year DFS with genemutation was superior to it without mutation, which had statistically significant. ThePIK3CA was sensitive genes of postoperative auxiliary chemotherapy with AC-Dprogram.2. Gene mutation of C-MET was related to the3-year DFS. The3-year DFSwithout gene mutation was superior to it with mutation, which had statisticallysignificant. The C-MET was resistance genes of postoperative adjuvant chemotherapy with AC-D program.3. Gene mutation of PIK3CA was negatively related to the age of patients, and theyoung patients had the tendency of gene mutation；which was positively bound up withthe clinical stage, and the T stage with gene mutation was later. Gene mutation ofC-MET was not correlation with the clinical stage、hormone receptor and lymph nodemetastasis.4. Gene mutation of C-KIT、MLH、STK11and TP53was not correlation with the3-year DFS of postoperative breast cancer patients. The gene of TP53was positivelyrelated to T stage, which was later with gene mutation.