| Objective:The paper is to explore the changes in circulating tumor cells(CTC)in peripheral blood before and after neoadjuvant chemotherapy(NAC)in patients with breast cancer and evaluate on the efficacy of NAC.It also investigates the predictive value of CTC changes after NAC 2nd cycle chemotherapy for the final chemotherapy effect.Methods:According to the inclusion and exclusion criteria,a prospective study was performed on 50 female patients with invasive breast cancer diagnosed by hollow needle biopsy and they were diagnosed as clinical stage II and III breast cancer by mammography,ultrasound,CT and bone scan from January 2017 to December 2018 in Department of Breast and Thyroid Surgery,Affiliated Zhongshan Hospital of Dalian University.The patient received TAC chemotherapy for at least 2 cycles before surgery.If the patient is unable to tolerate the treatment,or after 2 cycles,according to the Response Evaluation Criteria In Solid Tumor(RECIST),the tumor size is obviously unchanged or progress,then the chemotherapy is stopped and the standard surgery is performed in a month.If it is effective,it will continue to complete 6 courses of chemotherapy,and after chemotherapy,radical mastectomy will be performed.Peripheral blood venous blood was collected 7.5 ml each time from the healthy upper limb before the first chemotherapy,after the second cycle of chemotherapy,and the end of chemotherapy.Cellsearch system was adopted in detecting circulating tumor cells in peripheral blood within 72 hours.According to the change in CTC after NAC treatment,CTC reduction was defined as effective and CTC increased or unchanged was defined as ineffective.The relationship between the positive rate of CTC detection and the clinicopathological factors of primary tumor was compared byc~2test.Differences in CTC positive rates before and after NAC were compared using the McNemar test.The pathological(Miller-Payne)evaluation criteria were used as the standard,and the sensitivity,specificity,positive predictive value,negative predictive value and accuracy were calcuted to evaluate the efficacy of CTC changes in evaluating and predicting the curative effect of NAC.The Kappa test was used to analyze the consistency of CTC test and pathological evaluation.Results:The positive rate of CTC in patients with HER-2 positive,axillary lymph node positive,high Ki67 expression(≥15%),and high clinical stage was significantly higher than that of negative,low expression and low stage.There was no significant correlation between CTC positive rate and age,menopausal status and hormone receptor ER,PR and tumor size(P>0.05).The detection rate of CTC before NAC was 64.0%(32/50),and the detection rate of CTC after NAC was 22%(11/50).The positive rate of CTC after NAC treatment was significantly lower than that before treatment(P<0.05).3.The sensitivity of CTC test to evaluate the efficacy of NAC was 75.8%(22/29),specificity was 71.4%(15/21),misdiagnosis rate was 28.6%,missed diagnosis rate was 24.2%,and positive predictive value was 78.5%(22/28),negative predictive value:68.1%(15/22),effective rate:74%(37/50).The kappa test was used to analyze the consistency of CTC detection and pathological evaluation.The two evaluation methods were moderately consistent(kappa=0.470,P<0.05).4.The sensitivity of CTC changes after NAC 2nd cycle predicts the final efficacy of NAC:65.5%(19/29),specificity:76.1%(16/21),misdiagnosis rate:23.9%,missed diagnosis rate:34.5%,positive predictive value:79.1%(19/24),negative predictive value:61.5%(16/26),effective rate:70%(35/50).The kappa test was used to judge the consistency of the two evaluation methods.The results confirmed that the two evaluation methods were moderately consistent(kappa=0.404,P<0.05).Conclusions:1.Changes in CTC before and after NAC in breast cancer patients can be used to assess the efficacy of NAC to some extent.2.The change of CTC after the second cycle of chemotherapy can predict the final chemotherapy effect of the tumor to a certain extent. |
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