Heterogeneity Of Breast Cancer Tumors And The Correlation Of Efficacy Of Neoadjuvant Chemotherapy

Backgrounds:With the development of science and technology and the progress of diagnosis and treatment,the treatment of breast cancer has achieved significant curative effect and progress.But breast cancer is one of the most often malignant diseases in gynecology,and the incidence of the disease has increased,and it has shown a tendency to be younger.Breast cancer is treated with surgical treatment as a core treatment,with adjuvant therapy of radiotherapy and chemotherapy.and the neoadjuvant as a normal treatment for breast cancer,plays an important role.It is shown that between different types malignant tumor and in the same tumor cells,there is a certain diversity mutation in the chromosomal group,and this mutation also has different expression between the tumor cell line subcells with the same genetic background.It has been found that that cell proliferation ability and the sensitivity of the medicine can be different due to the existence of heterogeneity on the periodicity of the DNA cell cycle,so that the tumor cells with strong survival ability can produce the stable and progeny.A large number of studies have confirmed that the tumor heterogeneity of breast cancer patients will change Before and after neoadjuvant chemotherapy.After neoadjuvant chemotherapy,the mutant tumor cells with weak survival ability were killed,while he mutant tumor cells in survival that were not sensitive to treatment could proliferate again,causing tumor recurrence or metastasis.At the same time,the genetic instability and adaptive capacity of the tumor cells with recurrent or residual tumor were increased,and a large number of mutant clones were formed.With the advancement of science and technology,the research has found that molecular biological indicators are gradually adapting to the development needs of oncology research,including ER,HR,her-2 and ki-67.It is of great clinical significance and practical value to study the changes and differences of molecular biological indicators before and after neoadjuvant chemotherapy for the individualized treatment of breast cancer patients.Objective:This Article is aimed at comparing and analyzing the differences in molecular biological indicators(ER,PR,her-2 and ki-67)before and after neoadjuvant chemotherapy,and the correlation with the efficacy of chemotherapy.Then we can accurately predict the efficacy of neoadjuvant chemotherapy for breast cancer,provide a basis for treatment,so as to maximize the therapeutic effect.Materical and methods:From January 2015 to October 2017,patients with breast breast cancer were collected from Shandong university Qilu hospital.The core needle puncture biopsy was performed because of breast cancer according to the pathological results,then take the operation of NAC.All the patients were women,and the patients were not treated with special treatment before admission,and the primary diagnosis of breast cancer was breast cancer with different degrees of axillary lymph node metastasis.None of them have distant metastasis of breast cancer.After taking 2-6 cycle TEC or ET regimen neoadjuvant chemotherapy,they were treated with modified radical mastectomy or radical mastectomy.Then we obtaine routine pathology,histological grade,immunohistochemical index and lymph node metastasis rate.Then we evaluate the pathological reaction after chemotherapy based on miher-payne grading system.Results:1.84 cases of breast cancer patients were adopted into statistics in total.It includes 79 cases of the infiltrating ductal carcinoma,4 cases of invasive lobular carcinoma 4 cases,1 case of micro invasive papillary carcinoma,tumor size for 1-12 cm in diameter,patients with axillary lymph node enlargement was 71.43%(60/84),all patients were found no distant metastases.51 cases of patients take ET neo-adjuvant chemotherapy and 33 cases take the TEC neo-adjuvant chemotherapy.2.The change rate of ER,PR and Her-2 of NAC was 11.9%,16.7%and 23.8%respectively,and the change rate was no significant difference(P<0.05),and the change rate of Ki-67 was 49.3%,which was statistically significant.3.The change rate of ER,PR and Her-2 before and after NAC was not significantly correlated with MP classification(P>0.05),and the change rate of Ki-67 was correlated with MP classification,and showed a decreasing trend(P<0.05).4.Among various molecular types of breast cancer,Luminal,Her-2 overexpression and tri-negative breast cancer were compared,and the immunohistochemical indexes showed no significant difference before and after neoadjuvant chemotherapy(P>0.05).Compareing Her-2 overexpression with the other two types,and the her-2 index was significantly different,showing a negative trend(P<0.05).Conclusion:1.The indexes of ER,PR,her-2 and ki-67 were changed in different degrees before and after NAC,and there was no significant difference in ER,PR and Her-2,and the change of Ki-67 index after neoadjuvant chemotherapy was significantly decreased,and its change rate was significantly correlated with MP classification.The change of ki-67 index can be used as a predictor of the effectiveness of neoadjuvant chemotherapy.2.There’s no obvious difference between the heterogeneity of breast cancer.3.Compared with other two types,the Her-2 index of Her-2 overexpression was significantly different before and after neoadjuvant chemotherapy.Her-2 after neo-adjunctive chemotherapy can be easily transferred to negative.It is necessary to take FISH to detect that expression status of Her-2 for Her-2 expression type or post-chemotherapy.4.Changes in molecular markers before and after NAC reflect the heterogeneity of tumor cells.The heterogeneity of tumor and the changes of tumor biological behavior are of great significance for clinical prognosis and individualized treatment.