The Study Of Effect And Prognosis Of Neoadjuvant Chemotherapy For Triple-negative Breast Cancer

ObjectiveTo investigate the efficacy of neoadjuvant chemotherapy and the prognostic factors in patients with triple-negative breast cancer(TNBC). MethodsThe clinicopathologic features, response to neoadjuvant chemotherapy, disease-free survival and overall survival, and prognostic factors were retrospectively analyzed in 106 hospitalized TNBC patients,who were given neoadjuvant chemotherapy between January 2006 and December 2011.All of the patients accepted about 2-6 cycles of neoadjuvant chemotherapy before they had surgical treatments. The treatments of neoadjuvant chemotherapy were repeated every 21 days. All of the 106 patients were received surgical treatments and all of them had finished the chemotherapies.Part of them accepted radiation therapy.We judged clinical curative effect with the application of clinical evaluation(clinical touch, color dopplar ultrasound,breast X-ray radiography,breast MRI)and postoperative pathologic diagnosis.According to the RECIST1.1 solid tumor curative effect evaluation standard to evaluate curative effect of chemotherapy. We used immunohistochemistry to detect the expression of ER,PR,HER-2,Ki67 and P53 after neoadjuvant chemotherapy.Factors affecting the pCR was determinated by ?2 test and multivariate Logistic regression analysis.Kaplan-Meier unvariate analysis were used to calculate the survival rate and for the survival of the single factor analysis.Multivariate factors for survival were analyzed by Cox proportional hazards regression model. ResultsThe clinical efficacy: overal reponse rate(ORR) was 96.2%(102/106), pathological complete response(pCR) was 33.0%(35/106). Of the 106 TNBC patients receiving neoadjuvant chemotherapy, 46 cases of CR(43.4%),56 cases of PR(52.8%),3 cases of SD(2.8%),1cases of PD(1.0%). Significant correlations existed between pCR with patient age,tumor size and lymph node staging and clinical staging. The patients of age?40 years(P=0.020),tumor size?5cm(P=0.033), no lymph node metastasis(P=0.026) and early clinical stage(P=0.003) had higher pCR. Increased chemotherapeutic cycles could improve the rate of pCR(23.4% vs 47.6%).And the rate of pCR had significant difference between two regimens(P=0.010).The rate of pCR achieved by regimens of anthracycline plus taxane was higher(39.8%)than that by anthracycline-based regimens(11.8%). And the rate of pCR had significant difference between two regimens(P=0.027). Logistic multifactorial analysis showed that : age was an independent predictive factor for pCR rate to neoadjuvant chemotherapy.Young patients seemd to achieve higher pCR rates after NCT.The 5-year disease-free survival rates and overall survival rates of pCR patients were 87.3% and 90.2% respectively. The 5-year disease-free survival rates and overall survival rates of non-pCR patients were 50.1% and 55.9% respectively.Significant correlations existed in the 5-year disease-free survival rates and overall survival rates between pCR and non-pCR patients.Single factor analysis showed that lymph node staging(P=0.001,P=0.003),clinical staging(P=0.009,P=0.010)and pCR(P=0.000,P=0.000)were prognostic factors for the disease-free survival and the overall survival of patients. Multivariate analysis showed that pCR(P=0.005,P=0.005)was an independent prognostic factor for the disease-free survival and the overall survival of patients. ConclusionsThe efficacy of neoadjuvant chemotherapy for triple-negative breast cancer had correlation with age,tumor size,lymph node staging,clinical staging,chemotherapy regimens and chemotherapy cycles.In which the efficacy of neoadjuvant chemotherapy were better in the age?40, tumor size?5cm, no lymph node metastasis,early clinical stage, paclitaxel plus anthracycline-based and>3 cycles,and the pCR were higher. Age was an independent predictive factor for pCR rate to neoadjuvant chemotherapy. pCR was the independent prognostic factor for the disease-free survival and the overall survival of patients.Patients with TNBC were more sensitive to neoadjvant chemotherapy. TNBC patients with pCR may have a better prognosis than non-pCR.