| Objective:To investigate the relationship between the expression of immunohistochemical results ER,PR,Her-2,Ki67 and P53 in breast cancer and pathological complete response after neoadjuvant chemotherapy,and the relationship between the change of immunohistochemical results expression before and after neoadjuvant chemotherapy and pathological complete response,and to evaluate the sensitivity factors for predicting pathological complete response.By comparing the situation of residual lesions and prognosis after neoadjuvant chemotherapy for breast cancer,a new method to determine the prognosis was proposed,which provided certain reference for the individualized accurate treatment of breast cancer patients.Methods:Selection in November 2015 to December 2018 in the Huaihe hospital of the Henan university breast surgery by colour to exceed the hollow needle biopsy guided by diagnosed with invasive breast cancer and 89 patients as the research object of NAC,collect related basic clinical information,biopsy pathologic and immunohistochemical results,NAC and surgery,postoperative routine pathologic and immunohistochemical results were retrospectively analyzed.The data collected were statistically analyzed using SPSS 22.0 statistical software,in which the chi-square test was used for univariate analysis,and Fisher's exact probability method was applied to the data with the sample size less than 5.Logistic regression was used for multivariate analysis.Kaplan-Meier method was used to calculate the survival rate and draw the survival curve for univariate survival analysis,and Cox proportional risk regression model was used for multivariate analysis.P <0.05 was considered statistically significant.Results:Eighty-nine women were treated with combined or sequential chemotherapy with anthracyclines or taxanes for six or eight cycles.Trastuzumab targeted therapy is recommended for patients with positive Her-2.Among them,14 patients achieved pathological complete remission,and the pCR rate was 15.73%.After neoadjuvant chemotherapy,pCR was related to the expression of ER,PR,Her-2,Ki67 and molecular typing: the pCR rate of ER negative patients was higher(9.0% vs.6.7%),the pCR rate of PR negative patients was higher(12.3% vs.3.5%),the pCR rate of Her-2 positive patients was higher(9.0% vs.6.7%),and the pCR rate of Ki67 30% patients was higher(13.4% vs.2.3%).Type LuminalB pCR in different molecular classification rate is higher,the pCR rate LuminalB type 6.7%,respectively,its ehrs-2 expression type 5.6%,three negative 3.5%,and 0% LuminalA type.LuminalB,Her-2 expression was not related to pCR rate(P > 0.05).Multivariate analysis showed that Her-2 and Ki67 expression status were the sensitivity factors of pCR,with P values less than 0.05.The pCR rate of patients with positive Her-2 was higher(OR: 7.470,95%CI: 1.436-38.865).The pCR rate of patients with high Ki67 expression was higher(OR: 4.284,95%CI: 0.736-24.932).Before and after neoadjuvant chemotherapy,immunohistochemical results of breast cancer would change,and the expression changes of ER,Her-2,Ki67 and P53 were not related to the pCR rate,and the P values were all greater than 0.05.The change of PR was related to the rate of pCR.immunohistochemical results and prognosis of breast cancer: ER,PR,Her-2,Ki67,P53,pCR,and different molecular typing were not correlated with OS,P > 0.05.ER expression was independent of DFS,P > 0.05.PR,Her-2,Ki67,P53,pCR and different molecular typing were all correlated with DFS,P < 0.05.According to the survival curves of each group,the DFS of PR positive patients was higher than that of negative patients.Patients with positive Her-2 had higher DFS than those with negative Her-2.Patients with low expression of Ki67 had higher DFS than patients with high expression.DFS of P53 negative patients was higher than that of positive patients.The DFS of pCR patients were much higher than those without pCR.DFS of different molecular types were compared as follows: Her-2 over-expressed > LuminalA > LuminalB > triple negative.After neoadjuvant chemotherapy,the size of residual lesions and the number of lymph node metastases were grouped into residual lesions + lymph node metastasis group,and the score was correlated with DFS,and the higher the score,the lower the DFS.Multivariate survival analysis showed that PR,Her-2 and pCR were all related to DFS.Conclusion:1.Breast cancer immunohistochemical results ER,PR,her-2,Ki67 and P53 can predict the efficacy of neoadjuvant chemotherapy and assist in determining the prognosis of patients.2.Breast cancer immunohistochemical results and pCR before neoadjuvant chemotherapy: the pCR rate was higher in patients with ER negative,PR negative,her-2 positive and Ki67?30%.3.Changes in the expression of immunohistochemical results in breast cancer before and after neoadjuvant chemotherapy and pCR: changes in the expression of ER,her-2,Ki67 and P53 were unrelated to pCR rate,while changes in PR were related to pCR rate,and the pCR rate was higher in the group with no change in PR.4.immunohistochemical results and prognosis of residual breast cancer after neoadjuvant chemotherapy: patients with PR positive,her-2 positive,P53 negative and low expression of Ki67 had longer DFS;DFS of patients with pCR reached after neoadjuvant chemotherapy was much higher than that of patients without pCR.5.After neoadjuvant chemotherapy,the size of residual lesions and the number of lymph node metastases were divided into the residual lesions + lymph node metastases group,and the score was correlated with DFS,and the higher the score,the shorter the DFS. |
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