Predictors Of Pathological Complete Response And Efficacy After Neoadjuvant Chemotherapy For Breast Cancer In Young Women

ObjectsEvaluating the clinical effects and adverse reaction of 248 women under age 40 treatment with TAC(neoadjuvant chemotherapy,docetaxel + pirarubicin + cyclophosphamide).To identify the features of breast cancer in young women and the potential predictive factors obtained from the clinical data and immunohistochemistry in treatment of these patients with pathological complete response(pCR).Expect to plan management in a accurate fashion to optimize clinical outcomes.MethodsDuring Jan 2011 to Jul 2016,248 young breast cancer patients(age <40 years)were inclued in this retrospective study.Clinical efficacy and adverse reactions of Chemotherapy drug were reviewed from the patients in TAC treatment cohorts: docetaxel 500 mg/m2 + pirarubicin 50mg/m2 + cyclophosphamide 75mg/m2).Pathologic complete response was defined as the absence of invasive tumor in the breast and node.Clinical dates and the express of estrogen receptor(ER),progesterone receptor(PR),Ki-67,HER-2 and P53 were compared using Chi-square.Multivariate analyses were used to identify independent predictors of pCR.Results248 cases of young patients with breast cancer,invasive ductal carcinoma was 196 cases(79%),invasive lobular carcinoma was 9 cases(3.6%),other(medullary carcinoma,mucinous adenocarcinoma and other special types)invasive carcinoma was 43 cases(17.4%).Clinical pathological stage II was 159 cases(64.1%),stage III was 89 cases(35.9%).The tumor diameter was 2-5cm in 213 cases(85.9%),>5cm in 35 cases(14.1%).There were 141 patients with no axillary lymph node metastasis(56.9%),62 patients have1-3 lymph nodes metastasis(25%),and 45 patients hanve more than 3 lymph nodes metastasis(18.1%).Immunohistochemistry results were reviewed from 198 patients,ER(-)was 67 cases(33.8%),ER(?1%)was 131 cases(66.2%),PR(-)was 58 cases(29.3%),PR(?1%)was 140 cases(70.7%),Her-2(-)was 60 cases(30.3%),Her-2(+)was 138 cases(69.7%).P53 positive was108 cases(54.5%),and Ki-67 highly expressed was 145 cases(73.2%).luminal subtype was 126 cases(63.6%),TNBC subtype was 54 cases(27.3%).In 248 cases of patients,75 patients get partial remission(53.0%),15 cases of stable disease and 3 cases of progressive disease.objective response rate was 90.9%.pCR were detected in 53 patients(53/248,21.4%).In univariate analysis,we found BMI<24,BSA<1.7,clinical stage?,ki-67(+),triple negative breast cancer(TNBC)and ER(-)were correlated with pCR,and TNBC(OR=46.3,95%CI=1.046-18.474),ki-67(+)(OR=8.201,95% CI=1.970-34.135),clinic stage II(OR=5.011,95%CI=1.626-20.498),and BMI<24(OR=3.179,95%CI=1.022-9.855)were considered as independent prognostic factors in multivariate analysis Conclusions:1.The Invasive ductal carcinoma and triple negative breast cancer(TNBC)account for a large part of breast cancer in young women.2.TAC treatment agent have high efficacy and achieved high pathologic complete response rate,the toxic effects is tolerability profile.3.In young breast cancer patients,TNBC,Ki-67(+),BMI < 24 and clinical stage? are significantly corrected with pCR.