Re Analysis Of Molecular Subtypes Of Recurrent And Metastatic Breast Cancer And Clinical Study Of Radiotherapy Effect

Objective:Then analyze the clinicopathological characteristics of recurrent and metastatic breast cancer,compare the heterogeneity of molecular subtypes before and after recurrence and metastasis,and explore the correlation between different molecular subtypes and radiotherapy,so as to provide clinical basis for the development of individualized treatment plan for recurrent and metastatic breast cancer patients.Methods:A retrospective analysis of 123 female patients with recurrent metastatic breast cancer treated in our hospital from January 2014 to December 2019.All patients were local recurrence or distant metastasis after breast cancer surgery.Analyze their age,menopausal status and surgical methods of primary tumor,pathological type,histological grade,vascular tumor thrombus,clinical stage,ER(estrogen receptor),PR(progestin receptor),Her-2(human epidermal growth factor receptor 2),Ki-67(proliferation index),molecular subtypes,treatment methods and other clinical pathological features;pathological biopsy to confirm the diagnosis of recurrent metastases,and then analyze the metastases ER,PR,Her-2,Ki-67,molecular subtypes and other indicators of expression consistency and heterogeneity with the primary focus.At the same time,the efficacy of different molecular subtypes of breast cancer patients was compared and analyzed.Results SPSS 24.0 and SAS 9.4 statistical software were used for statistical analysis.Comparisons between groups were tested by 2 tests.Consistency analysis of the expression of each index between primary and recurrent metastases was analyzed by paired design.Four-sheet Mc Nemar’s test.To explore the cross-effects of the relationship between postoperative radiotherapy and molecular subtypes on survival prognosis,to quantify the effect of postoperative radiotherapy(RT + VS RT-)and molecular subtype crossover groups on PFS,univariate and multifactorial Cox proportional hazard regression The model analyzes the effects of radiotherapy or not and molecular subtypes on PFS.The test level was α = 0.05,and P <0.05 was considered statistically significant.Results:1.Comparison of primary indicators and recurrent metastases in 123 patients: ER expression consistent rate was 80.5%(99/123),PR expression consistent rate was 75.6%(93/123),and Her-2 expression consistent rate was 87.0 %(107/123),Ki-67 expression consistency was 74.0%(91/123).The heterogeneity of ER,PR,Her-2,and Ki-67 expression in the two groups was 19.5%,24.4%,13.0%,and 26.0%,respectively.The heterogeneity of PR and Ki-67 expression was statistically different,P <0.05.2.Comparison of different molecular subtypes between primary and recurrent metastases in 123 patients: The expression of different molecular subtypes between primary tumors and recurrent metastases was different,P <0.05,and the statistical value of consistency test P> 0.05,no significant statistical difference,indicating that different molecular subtypes have better consistency in the lesions before and after cancer progression,showing heterogeneity between tumors,molecular subtype heterogeneity accounts for 40.7%(50/123),Her-2 enrichment in the recurrence and metastasis group The expression rate of genotype is significantly higher than that of other molecular subtypes.The change of molecular subtypes has caused about 34% of patients to modify the original treatment plan.4.Comparison of the effects of different molecular subtypes on the prognosis of radiation therapy: Her-2 enriched molecular subtype in the non-radiotherapy group is an independent risk factor for cancer progression(P <0.05).Conclusion:1.The biological indexes ER,PR,HER-2,Ki-67 and their molecular subtypes are heterogeneous in the expression between primary and recurrent metastasis.The high expression of Ki-67 and the negative transformation of PR receptor are the risk factors of tumor progression.2.It is very important for the decision-making of the treatment to carry out the re biopsy of the recurrence and metastasis of breast cancer,and provide the clinical diagnosis and treatment basis for the individual treatment of the recurrence and metastasis of breast cancer.3.Radiotherapy is a protective factor for HER-2 enrich breast cancer,and it is a necessary treatment for high-risk breast cancer patients.