Hormone Receptor Change During Treatment And Endocrine Therapy Compliance In Breast Cancer

ObjectivesBreast cancer is one of the most common malignant tumors in the world.Deaths from breast cancer have increased over the past decades.In China,increasing number of patients are being diagnosed with breast cancer in recent years.Under this circumstance,a set of comprehensive treatments have been developed including surgery,chemotherapy,radiotherapy,endocrine therapy,biological target therapy,which have made breast cancer a curable disease with a favorable prognosis.A great amount of researches have been proved that the biomarkers,such as estrogen receptor,can be altered in the process of treatment while receiving neoadjuvant chemotherapy or puncture.It also can be altered when the tumor tends to have a recurrence and metastasis.The purposes of this paper were to retrospectively analyze the pathological data of the breast cancer patients and explore how biomarkers,such as ER,PR,HER-2,Ki-67,altered during neoadjuvant chemotherapy and recurrence and metastasis.The postoperative survival of each group of patients was also analyzed and survival curves were drawn.In addition,we analyzed the endocrine therapy compliance of patients to provide the guidance for clinical treatments.MethodsPatients data was collected in Qilu hospital in Shandong province between January 2005 to June 2016.We examined 301 cases of breast cancer patients with neoadjuvant chemotherapy,71 cases with preoperative puncture,39 cases with recurrence or metastasis and 1839 cases with adjuvant endocrine therapy.Retrospectively analyze the pathological data and immunohistochemistry(IHC)results of ER and PR expression and HER-2 expression of patients with neoadjuvnat chemotherapy,preoperative puncture and recurrence and metastasis.We contrasted patients with NAC with patients with preoperative puncture to eliminate the effects of puncture.The categories and compliance of endocrine drugs administrated were analyzed.Statistical analysis such as chi-square test was performed by Statistical Package for Social Science software(SPSS 23.0)ResultsNo statistical differences were found in Her-2 status(p=0.105),but a significant statistical difference was found in ER(p<0.001),and PR(p=0.03)status between NAC treated cases and controls,which changed from positive to negative following NAC.An ER change from negative to positive was seen in small percentages of both NAC treated cases(9.8%)and controls(7.6%),while 8.4%and 4.3%in PR.In patients with recurrence or metastasis,no statistical differences were found in PR(p=0.608),Her-2(p=0.105)and Ki-67(p=0.240)status,while a significant statistical difference was found in ER(p=0.032)status between primary tumor and recurrent or metastatic tumor,which changed from positive to negative.An ER change from negative to positive was seen in small percentages of both primary and recurrence or metastatic tumor(2.7%).Most premenopausal patients chose tamoxifen as endocrine therapy drug,while a few patients chose toremifene because of the adverse reaction of tamoxifen,such as endomentrial thickness.The five-year compliance rate was low because of few adverse reactions.Postmenopausal patients administrated aromatase inhibitor as endocrine therapy drug.The five-year compliance rate was low because of serious adverse reactions.The main factors that lead to the reduction of drug compliance was adverse reactions.ConclusionBoth NAC treated patients and recurrent or metastatic patients showed a significant statistical difference in ER and PR status.It is of vital importance for us to reevaluate IHC after NAC or metastasis.The compliance of patients receiving endocrine therapy remains to be improved.Doctors should take hormone receptor status,adverse reactions and economic factors into account while selecting endocrine therapy drugs to realize the precise treatment of breast cancer.