Analysis Of Neoadjuvant Chemotherapy For Locally Advanced Breast Cancer With Different Molecular Types And The Relevant Research

ObjectiveTo explore the relationship between the efficacy of neoadjuvant chemotherapy and its molecular typing in locally advanced breast cancer,and to clarify the therapeutic effect of neoadjuvant chemotherapy in locally advanced breast cancer with different molecular typing.To further explore the expression of biological factors in neoadjuvant chemotherapy,in order to provide more accurate evaluation means for clinical treatment.MethodsA total of 86 patients with locally advanced breast cancer diagnosed and receiving neoadjuvant chemotherapy from September 2013 to September 2018 in the Department of Mammary Surgery,our hospital were collected.Before neoadjuvant chemotherapy,hollow needle aspiration biopsy was performed in all patients.The expression levels of estrogen receptor(ER),progesterone receptor(PR),epidermal growth factor receptor 2(HER-2)and Ki-67 were detected by immunohistochemistry and fluorescence in situ hybridization(FISH).The patients were classified as Luminal A,Luminal B,HER-2 positive and Ki-67 negative.The patients were divided into four groups:group A(Luminal A),group B(Luminal B),group C(HER-2 positive)and group D(three negative).All patients received baseline assessment before neoadjuvant chemotherapy,including medical history,physical examination,B-mode ultrasound,molybdenum target,PET-CT and pathological examination.The neoadjuvant chemotherapy regimens for all patients were:epirubicin(60-70)mg/m~2intravenous drip d1;docetaxel 75 mg/m2 intravenous drip d1;21 days as a cycle,3-4cycles before operation.All patients received modified radical mastectomy at the end of chemotherapy.The baseline assessment was made again before operation.The expression level of biological factors in the surgical specimens was determined by the same immunohistochemical method.Comparing the two baseline assessment data,we calculated the pathological and clinical remission rates of patients.As an indicator of therapeutic effect evaluation,we compared the difference of therapeutic effect of neoadjuvant chemotherapy among different molecular types,and observed the relationship between the therapeutic effect of neoadjuvant chemotherapy and its molecular typing in locally advanced breast cancer patients.To observe the expression of biological factors before and after neoadjuvant chemotherapy,and to analyze the correlation with therapeutic effect.To compare the value of each examination method in the evaluation of curative effect.Results1.A total of 86 patients were enrolled in this study,including 17 in Group A(19.8%),26 in Group B(30.2%),21 in Group C(24.4%)and 22 in Group D(25.6%).The age,nationality,menstrual status,neoadjuvant chemotherapy cycles and other general clinical data of the four groups were tested by X~2,and there was no significant difference among the groups(P>0.05).2.The pathological types,T stage,regional lymph node status and clinical stage of breast cancer in the four groups were examined by X~2.There was no significant difference among the groups(P>0.05).3.The total pathological complete remission(pCR)rate of all subjects after neoadjuvant chemotherapy was 17.4%.The pCR rates of group A,group B,group C and group D were 5.9%,3.8%,33.3%and 27.3%,respectively.There was significant difference in the pCR rates among groups(P<0.05).The pCR rate of group C and group D was higher than that of group A and group B.There was significant difference between groups(P<0.05).4.The total pathological effective rate after neoadjuvant chemotherapy was31.4%.The pathological effective rates of group A,group B,group C and group D were 11.8%,11.5%,57.1%and 45.5%,respectively.There was significant difference in pathological effective rates among groups(P<0.05).The pathological effective rate of group C and group D was higher than that of group A and group B.There was significant difference between groups(P<0.05).5.The total clinical effective rate(RR)after neoadjuvant chemotherapy was77.9%.The RR rates of group A,group B,group C and group D were 64.7%,61.5%,95.2%and 90.9%,respectively.There was significant difference in RR rates among groups(P<0.05).The RR rate of group C and group D was higher than that of group A and group B.There was significant difference between groups(P<0.05).6.The expression of ER,PR and HER-2 in some patients changed before and after neoadjuvant chemotherapy,but there was no significant difference between the two groups(P>0.05).7.The Kappa values of clinical physical examination,breast B-ultrasound,molybdenum target and PET-CT were 0.288,0.535,0.406 and 0.829 respectively.Conclusions1.Neoadjuvant chemotherapy is more effective in patients with HER-2 positive and triple negative locally advanced breast cancer.Molecular typing of breast cancer can be used as a predictor of the efficacy of neoadjuvant chemotherapy in locally advanced breast cancer.2.Some biological factors may change in patients with locally advanced breast cancer before and after neoadjuvant chemotherapy,but this study did not find any correlation between the changes of biological factors and the efficacy of neoadjuvant chemotherapy.3.In the evaluation of the efficacy of neoadjuvant chemotherapy,the consistency between clinical examination and pathological evaluation is not good,the consistency between breast B-ultrasound,molybdenum target and pathological evaluation is general,and the consistency between PET-CT and pathological evaluation is good and the accuracy of evaluation is high,so the effect of evaluation is ideal.