Correlation Study Of Biomarker Expression With Efficacy And Prognosis Before And After Neoadjuvant Therapy In Breast Cancer

Objective:In this study,biomarkers of primary and axillary lymph nodes before and after neoadjuvant therapy in breast cancer patients were collected,including estrogen receptor(ER)and progesterone receptor,respectively.PR),Human epidermal growth factor receptor 2(HER2),Ki-67,as well as patients’clinicopathological characteristics,treatment plans and prognostic information,to analyze different types of breast cancer.Including the correlation between the expression and changes of primary biomarkers before and after neoadjuvant therapy for hormone receptor positive,HER2 positive and triple negative breast cancer and the efficacy and prognosis of neoadjuvant therapy,and the heterogeneity of primary and lymph node biomarkers was explored.Methods:A total of 325 patients who received neoadjuvant therapy in the Department of Breast Oncology,Fifth Medical Center,PL A General Hospital from May 2015 to April 2019 were collected in the study.The correlation of biomarker information and changes before and after treatment with neoadjuvant efficacy and prognosis was analyzed.And primary and lymph node biomarker heterogeneity.Chi-square test was used to analyze the relationship between biomarker expression and pCR rate.Kaplan-Meier curve was used to draw EFS curves of patients with different biomarkers,and the 5-year EFS rates were compared.Kappa Test was used to test the consistency of ER,PR and HER2 expression status,and McNemar Test was used to test the difference.SPSS 25.0 software was used for all statistical methods in this study,and P<0.05 was considered statistically significant.Results:1.ER negative,PR negative and HER2 positive before neoadjuvant therapy were associated with better pCR rates.Patients with high Ki-67 expression in triple-negative and Luminal types had a higher pCR rate than those with moderate and low expression.The expression of ER,PR,HER2 and Ki-67 in the primary lesion before neoadjuvant therapy did not affect the 5-year EFS rate.2.Among patients who did not reach pCR after neoadjuvant therapy,the 5-year EFS rate was higher in ER positive patients than in ER negative patients,and the 5-year EFS rate in Luminal patients was higher in patients with Ki-67<15%than in patients with Ki-67≥15%.3.The consistency of ER,PR and HER2 before and after neoadjuvant therapy was 95.7%,79.1%and 91.0%,respectively,and the expression level of Ki-67 showed a downward trend on the whole.HER2 acquisition after neoadjuvant therapy was associated with worse EFS.Her2-positive HR negative patients with Ki-67 decline group had better EFS than those without Ki-67 decline group.4.The consistency of ER,PR and HER2 between the primary lesion and axillary lymph nodes before neoadjuvant therapy was 94.4%,93.1%and 97.0%,respectively.Conclusion:1.Pre-neoadjuvant biomarkers predict neoadjuvant effi cacy:Negative ER,PR,positive HER2,and high Ki-67 expression before neoadjuvant therapy are associated with better pCR rates in the overall population,but do not predict long-term prognosis.2.Biomarkers predict long-term prognosis after neoadjuvant therapy:Hormone receptor-positive,HER2-negative,and low Ki-67 expression were associated with better EFS in patients who did not reach pCR after neoadjuvant therapy.For patients with high Ki-67 after neoadjuvant therapy,follow-up intensive therapy may be considered to improve the prognosis.3:Primary lesions were highly consistent with lymph node biomarkers before neoadjuvant therapy.However,about 10%of patients with negative primary hormone receptors have positive lymph node hormone receptors,and lymph node immunohistochemical testing can be performed in order to obtain more treatment options.4.Primary biomarkers were inconsistent before and after neoadjuvant therapy.It is suggested that immunohistochemical detection of residual lesions should be performed after neoadjuvant therapy to better guide postoperative treatment.