Analysis of the relevance between molecular subtypes and efficacy of neoadjuvant chemotherapy in breast cancer as well as its prognostic factors.

BACKGROUND: Accurate pathological assessment of breast specimens after NACT is crucial. It is beneficial to determine the treatment efficacy and predict prognosis. So we should explore the relevance between molecular subtypes and efficacy of neoadjuvant chemotherapy in breast cancer as well as its prognostic factors, which about survival analysis and disease free survival involved, which was one part of contributing for evaluating in terms of global survival and disease free survival.

METHODS: Medical records of 264 patients with breast cancer who received neoadjuvant chemotherapy in Breast Center, the Fourth Hospital of Hebei Medical University, between January 2008 and May 2013. The relationship between molecular subtypes and neoadjuvant chemotherapy, and clinical pathological features were analyzed.

RESULTS: The total pCR rate was 12.50% (33/264). The rate of pCR were 3.03% (1/33), 9.40% (14/149), 17.39%(8/46), 27.78% (10/36) in Luminal A type, Luminal B type, HER2 overexpression type, and Triple negative type, respectively. Which was predicted that The pCR rate associated with breast cancer molecular subtypes (P < 0.05). The pCR rate in Triple negative type was highest, HER2 overexpression type was showed higher pCR rate than Luminal A and Luminal B type. Multiple factors analysis results showed that: the independent impact factors of 5-year overall survival rate in neoadjuvant chemotherapy breast cancer patients were clinical stage, tumor size, chemotherapy regimens, lymph node metastasis, estrogen receptor status and pathological remission; the independent impact factors of 5-year disease free survival rate were tumor size, chemotherapy regimens, estrogen receptor status, progesterone receptor status and pathological remission (P < 0.05). Triple negative type of breast cancer had shorter overall survival and disease-free survival (P < 0.05).

CONCLUSIONS: The pCR was more frequently observed in HER2 overexpression type and Triple negative type of breast cancer. That could achieve a higher rate of pCR on paclitaxel class joint anthracycline-based chemotherapy. But Triple negative type showed worse prognosis, due to residual tumor after neoadjuvant chemotherapy, which could be in combination or sequential, at the neoadjuvant / adjuvant setting (NCCN 2016 Breast cancer, chemotherapy regimens), So how to choose a more appropriate neoadjuvant chemotherapy regimens, we should need further research.