A Systematic Review On The Efficacy Of Neodjuvant Chemotherapy For Operative Breast Cancer In Current Treatment

Objective:To evaluate the effects of neoadjuvant chemotherapy on surgery procedures and long-term efficacy in the operable breast cancer when compare to adjuvant chemotherapy.Methods:searching electronic database of the Cochrane Library, EMBASE, PubMed (1978-2015.12), CNKI (1994-2015) for randomized controlled trial (RCT) comparing neoadjuvant chemotherapy (NAC) plus mastectomy or breast conserving surgery with mastectomy or breast conserving surgery plus postoperative chemotherapy.Patients enrolled shuold have the TNM staging limited to T1-3N0-2M0, and received a total of at least four courses chemotherapy(before operation at least 2 courses of chemotherapy). Assesing the quality of the randomized controlled trial and extract effective data for the meta-analysis according to the Cochrane Collaboration evaluation method according to the Cochrane Collaboration evaluation method.Results:a total of 5 RCT including 3608 patients were included, and the median follow-up was 7 years to 10 years. The results of Meta analysis showed that:1. there was no significant difference in overall survival between the neoadjuvant chemotherapy group and the adjuvant chemotherapy group (RR=0.99,95%CI (0.94,1.04), P=0.67].2. there was no significant difference in survival between neoadjuvant chemotherapy and adjuvant chemotherapy [RR=1.03,95%CI (0.94,1.12), P=0.52].3. there was no significant difference in the recurrence rate between the neoadjuvant chemotherapy group and the adjuvant chemotherapy group (RR=0.92,95%CI (0.67,1.25), P=0.59].4.there was no significant difference in the rate of distant metastasis [RR=1.18,95%CI (1,1.39), P=0.05].5. there was no significant difference in the recurrence rate of breast cancer after breast conserving surgery (RR=1.40,95%CI (0.94,2.10), P=0.10Conclusion:1.NAC does not affect the 9 years DFS and OS in operative breast cancer; 2. It is not certain that NAC could reduce the trend of LRR in operative breast cancer; 3. NAC does not affect the rate of distant metastasis in patients with operable breast cancer;4.NAC improves the conserving rate in operable breast cancer; 5. pateins conserving with downstaged breast caner has higher IBTR compared to the initial breast-conserving; 6. There is a certain benefit for patients downstaged breast cancer by NAC who having conserving surgery, but it does not change its prognosis.7.pCR suggests better prognosis.