| Objective:The data of GLOBAN 2012 show that in women with malignant tumors,the incidence of breast cancer was the highest,and the mortality ranked second.Breast cancer with a younger age of onset,and breast cancer patients on the appearance and cosmetic requirements also will be higher.Therefore,the promotion of breast-conserving surgery has become the trend of the times.To investigate the feasibility of breast conserving therapy(BCT)for locally advanced breast cancer after neoadjuvant chemotherapy(NAC).Methods:The clinicopathological data from 114 patients with breast cancer treated in our hospital between January 2006 and December 2008 were retrospectively reviewed.Including TNM staging ?a 21 cases,?b 69 cases,?a 24 cases,after neoadjuvant chemotherapy combined with breast conserving surgery in 35 patients,combined with breast cancer radical surgery in 79 cases.The correlation between age,lactation,tumor size,axillary node status,surgical approach,pathological stage,indicators of immunohistochemistry treatment modality,and prognosis was analyzed using statistical software.Results:The median follow-up time was 78 months.We evaluated the cosmetic results after breast surgery,the rate of good is 85.7%(30/35).In the BCT group the overall survival rates of stage ? and ? were 96.8% and 100%,respectively and the disease-free survival rate was 93.5% and 75.0% respectively.And the overall survival rates of stage ? and ? were 86.4% and 70.0% respectively,and the disease-free survival rate was 78.0% and 60.0% respectively in the MX group.There was no significant difference in the overall survival rate(P=0.156,P=0.209,respectively)and disease-free survival rate(P=0.091,P=0.203,respectively)between the two groups.Univariate analysis of patients with neoadjuvant chemotherapy showed that the later the clinical stage,the worse the prognosis(OS: P = 0.035;DFS: P = 0.011).The disease-free survival rate of patients with ER receptor positive was higher than that ofnegative patients and had statistical Significance(OS: P = 0.068;DFS: P = 0.021).The disease-free survival rate and overall survival rate of PR-positive patients were better than those of negative patients(OS: P = 0.016;DFS: P = 0.017).HER2 positive means a worse prognosis of the patients(OS: P = 0.001;DFS: P = 0.111),and pathological molecular typing also had an impact on prognosis.In this study,HER-2 overexpression breast cancer patients had the worst prognosis,which is related to the absence of targeted therapy in HER-2-positive patients.Univariate analysis of NAC-BCT showed that the first tumor size had a significant effect on the prognosis of the breast-conserving group(P <0.001),however family history of cancer,lymph node metastasis,ER,PR,HER-2,postoperative radiotherapy had no statistical significance.(P> 0.05).Multivariate analysis showed that clinical staging was an independent prognostic factor for disease-free survival and overall survival(P=0.011;P=0.027,respectively).The later the clinical stage,the worse the prognosis.The efficacy of neoadjuvant chemotherapy was also an independent prognostic factor for disease-free survival and overall survival(P=0.018;P=0.015,respectively),and HER-2 receptor positive was an independent prognostic factor for overall survival(P=0.031).Conclusion:1.Neoadjuvant chemotherapy combined with breast-conserving surgery is safe and feasible,can achieve better cosmetic results,can greatly improve the quality of life of patients,no significant decline in survival.2.Univariate analysis of patients with neoadjuvant chemotherapy showed that the later the clinical stage,the worse the prognosis(OS: P = 0.035;DFS: P = 0.011).The disease-free survival rate of patients with ER receptor positive was higher than that of negative patients and had statistical Significance(OS: P = 0.068;DFS: P =0.021).The disease-free survival rate and overall survival rate of PR-positive patients were better than those of negative patients(OS: P = 0.016;DFS: P = 0.017).HER-2positive means a worse prognosis of the patients(OS: P = 0.001;DFS: P = 0.111),and pathological molecular typing also had an impact on prognosis.In this study,HER-2 overexpression breast cancer patients had the worst prognosis,which is related to the absence of targeted therapy in HER-2-positive patients.Univariateanalysis of NAC-BCT showed that the first tumor size had a significant effect on the prognosis of the breast-conserving group(P <0.001),however lymph node metastasis,ER,PR,HER-2,postoperative radiotherapy had no statistical significance.(P> 0.05).3.Multivariate analysis showed that clinical staging was an independent prognostic factor for disease-free survival and overall survival(P=0.011;P=0.027,respectively).The later the clinical stage,the worse the prognosis.The efficacy of neoadjuvant chemotherapy was also an independent prognostic factor for disease-free survival and overall survival(P=0.018;P=0.015,respectively),and HER-2 receptor positive was an independent prognostic factor for overall survival(P=0.031). |
PDF Full Text Request