A Study On The Correlation Between The Pathological Features And Treatment And Prognosis Of HER-2 Positive Breast Cancer

Objective:By collecting and collating various clinical data of HER-2 positive breast cancer,and to discuss the impact of different clinicopathological features and therapies on survival and provide references for further study and evaluate the prognosis of HER-2 positive breast cancer patients.Methods:A total of 92 patients with HER-2 positive breast cancer who underwent surgical treatment in The first affiliated hospital of dalian medical university from January 2012 to December 2016 and had complete clinicopathological features and follow-up data were enrolled.By referring to the electronic medical records,the baseline data of the subjects were sorted out,mainly including the age of onset,menstrual status,family history,tumor stage,tumor size,lymph node status,histological grade,ki-67score,P53 status,vascular cancer thrombus,estrogen and progesterone receptor status,and treatment plan.The survival status of HER-2 positive breast cancer was followed up by referring to medical records and telephone.Statistical analysis was performed using SPSS 23.0 software.Survival rate of HER-2 positive breast cancer was assessed by Kaplan-Meier method,Single factor analysis of prognostic risk factors was carried out by X~2text,and independent prognostic factors were analyzed by binary Logistic regression for the statistically significant differences,P<0.05 was considered as the difference significance criterion.Results:1.Clinical pathological features:A total of 92 HER-2 positive breast cancer patients with complete clinicopathologic features were collected,of which 41 were HR positive(44.5%)and 51 were HR negative(55.4%).In the whole group,there were 5cases(5.4%)with the age of onset≤35 years old,and 55 cases(59.8%)with the age of onset>50 years old.The median age of onset was 53 years old;55 patients(59.8%)were postmenopausal at the time of onset.The pathological stage of tumor was stage I-III,68 patients of stage I-II,accounting for 73.9%and 24 patients with stage III accounting for about 36.1%.The maximum tumor diameter of 46.7%patients was less than or equal to 2cm(43/92 cases),and 51.1%of the lymph nodes metastasis(47/92cases).22.8%of the patients had vascular tumor thrombus.P53 was negative in 22 cases(24.0%).2.The follow-up time for this study was 3.4-93.9 months,with a median follow-up time of 54.3 months.During the follow-up time,there are 8 patients had Local-Regional Recurrence,15 patients had distant metastases,and 2 patients died.Within 3 years,there were 5 patients had Local-Regional Recurrence,9 patients had distant metastases,and11 patients had Local-Regional recurrence or distant metastasis.The 3-year disease-free survival rate and 3-year local-regional recurrence failure free survival rate were 88.0%and 94.6%,respectively.3.In the univariate analysis of the prognosis and clinicopathological features of HER-2 positive breast cancer,tumor pathological stage,tumor T stage,tumor N stage and vascular thrombus had statistical significance on the disease-free survival rate and local-regional recurrence failure free survival rate.Further multivariate analysis showed that tumor T stage was an independent influencing factor for disease-free survival and local-regional recurrence failure free survival rate.4.In the univariate analysis of treatment methods and prognosis,there was no statistical difference between the completion of chemotherapy and 3-year DFS rate and LRFFS rate(P>0.05),.However,the 3-year DFS rate of the completed chemotherapy group was better than that of the non-chemotherapy and unfinished chemotherapy.Patients who completed 1 year of anti-HER-2 targeted therapy improved 3-year DFS rate by 14.2%compared with patients who did not receive targeted therapy,but the LRFFS rate was not improved by targeted therapy.For breast cancer patients with pathological stage of T1-2N1M0,The 3-year DFS rates of the radical mastectomy combined radiotherapy group and the radical-only operation group were 66.7%and83.3%(P=0.84),and the 3-year LRFFS rates were 83.3%and 91.7%(P=1.00),showing no statistical significance.Since only 6 patients received radiotherapy in stage T1-2N1M0 after radical mastectomy,the number of cases was small,which may lead to inaccurate results.For HR-positive breast cancer patients,there was no significant statistical difference between the endocrine treatment and 3-year DFS and LRFFS(P>0.05).5.This study is a retrospective study with a small number of cases,which may have a certain impact on the results of the study.Looking forward to the large-scale prospective study in the next step.Conclusion:1.Tumor pathological staging,tumor size,lymph node status and vascular tumor thrombi are important prognostic factors for HER-2 positive breast cancer.2.Tumor T stage is an independent prognostic factor for disease-free survival and local-regional recurrence in HER-2 positive breast cancer.3.For HER2-positive breast cancer patients,chemotherapy can prolong disease-free survival;targeted therapy can improve the disease-free survival rate for HER-2positive breast cancer patients,but has little effect on the local-regional recurrence failure free survival rate.