3.1. Characteristics of study sample
Table 1. Descriptive characteristics and treatments of BC patients by parity status.
Patients characteristic
|
Parity status
|
P
|
Nulliparous
|
PPBC
|
Parous>5
|
N(%)
|
N(%)
|
N(%)
|
Total
|
|
47 (6.6)
|
40 (5.6)
|
627 (87.8)
|
|
Age at diagnosis
|
≤40
|
22 (46.8)
|
33 (82.5)
|
61 (9.7)
|
<0.001
|
|
>40
|
25 (53.8)
|
7 (17.5)
|
566 (90.3)
|
|
Surgical methods
|
BCS
|
6 (12.8)
|
7 (17.5)
|
21 (3.3)
|
<0.001
|
|
M
|
41 (87.2)
|
33 (82.5)
|
606 (96.7)
|
|
Menstruatio
|
Yes
|
13 (27.7)
|
1 (2.5)
|
333 (53.1)
|
<0.001
|
|
No
|
34 (72.3)
|
39 (97.5)
|
294 (46.9)
|
|
BMI
|
≤18.5
|
1 (2.1)
|
2 (5.0)
|
13 (2.2)
|
0.564
|
|
18.5-24
|
25 (53.2)
|
20 (50.0)
|
263 (41.8)
|
|
|
24-30
|
19 (40.4)
|
16 (40.0)
|
311 (49.6)
|
|
|
≥30
|
2 (4.3)
|
2 (5.0)
|
40 (6.4)
|
|
Clinical T stage
|
1
|
6 (12.8)
|
5 (12.5)
|
75 (11.9)
|
0.245
|
|
2
|
28 (59.6)
|
26 (65.0)
|
452 (72.0)
|
|
|
3
|
13 (27.6)
|
9 (22.5)
|
100 (16.1)
|
|
Clinical N stage
|
0
|
6 (12.8)
|
7 (17.5)
|
83 (13.2)
|
0.984
|
|
1
|
25 (53.2)
|
20 (50.0)
|
332 (52.9)
|
|
|
2
|
6 (12.8)
|
6 (15.0)
|
78 (12.4)
|
|
|
3
|
10 (21.2)
|
7 (17.5)
|
134 (21.5)
|
|
Lymphatic infiltration
|
Yes
|
31 (66.0)
|
32 (80.0)
|
470 (75.0)
|
0.421
|
|
No
|
16 (34.0)
|
8 (20.0)
|
157 (25.0)
|
|
ER
|
Positive
|
31 (66.0)
|
17 (42.5)
|
349 (55.6)
|
0.090
|
|
Negative
|
16 (34.0)
|
23 (57.5)
|
278 (44.6)
|
|
PR
|
Positive
|
23 (48.9)
|
16 (40.0)
|
273 (43.6)
|
0.686
|
|
Negative
|
24 (51.1)
|
24 (60.0)
|
354 (56.4)
|
|
HER-2
|
Positive
|
16 (34.0)
|
18 (45.0)
|
232 (36.9)
|
0.535
|
|
Negative
|
31 (66.0)
|
22 (55.0)
|
395 (63.1)
|
|
KI67
|
≤15
|
12 (25.5)
|
13 (32.5)
|
216 (34.4)
|
0.453
|
|
>15
|
35 (74.5)
|
27 (67.5)
|
411 (65.6)
|
|
P53
|
0
|
30 (63.8)
|
21 (52.5)
|
305 (48.6)
|
0.583
|
|
1
|
8 (17.0)
|
11 (37.5)
|
160 (25.5)
|
|
|
2
|
4 (8.6)
|
4 (10.0)
|
76 (12.1)
|
|
|
3
|
5 (10.6)
|
4 (10.0)
|
86 (13.8)
|
|
Histological grade
|
0-1
|
16 (34.0)
|
17 (42.5)
|
218 (34.7)
|
0.789
|
|
2
|
27 (57.4)
|
19 (47.5)
|
332 (53.0)
|
|
|
3
|
4 (8.6)
|
4 (10.0)
|
77 (12.3)
|
|
Stage
|
I
|
0 (0)
|
1 (2.5)
|
11 (1.8)
|
0.828
|
|
II
|
25 (53.2)
|
22 (55.0)
|
359 (57.3)
|
|
|
III
|
22 (46.8)
|
17 (42.5)
|
257 (40.9)
|
|
Molecular subtype
|
HR+/HER-2+
|
9 (19.1)
|
6 (15.0)
|
71 (11.3)
|
0.140
|
|
HR+/HER-2-
|
22 (46.8)
|
11 (27.5)
|
283 (45.1)
|
|
|
HR-/HER-2+
|
7 (14.9)
|
12 (30.0)
|
162 (25.8)
|
|
|
TNBC
|
9 (19.2)
|
11 (27.5)
|
111 (17.8)
|
|
Histological type
|
IDC
|
31 (66.0)
|
25 (62.5)
|
442 (70.5)
|
0.280
|
|
ILC
|
5 (10.6)
|
3 (7.5)
|
69 (11.0)
|
|
|
DCIS
|
3 (6.4)
|
4 (10.0)
|
19 (3.0)
|
|
|
Others
|
8 (17.0)
|
8 (20.0)
|
97 (15.5)
|
|
Chemotherapy regimen
|
Anthracycline-based
|
42 (89.4)
|
34 (85.0)
|
568 (90.6)
|
0.504
|
|
Other therapy
|
5 (10.6)
|
6 (15.0)
|
59 (9.4)
|
|
Bold values indicate that they are statistically significant at P ≤0.05
From January 1, 2012 to May 31, 2023, 1343 patients diagnosed with BC were studied at Harbin Medical University Cancer Hospital, 629 patients were excluded (472 patients without complete information, 93 patients discontinued or transferred, 13 patients diagnosed with occult BC, 1 male patient, 50 stage IV BC), and a total of 714 were included in the study. A total of 667 BC patients had a history of pregnancy, 40 patients with PPBC, 627 BC patients with Parous > 5 years, and 40 unproductive patients. The clinicopathological characteristics and treatment are shown in Table 1. The age distribution of the patients who delivered is shown in Figure 2. The age range was 21-71 years, with a median age of 48 years. More women gave birth at the age of 24 years. Different gestational status was strongly associated with age at diagnosis, menopausal status and surgical procedure (P < 0.05). In this cohort, PPBC patients were younger than other types of patients. 33 patients (82.5%) were diagnosed with BC before the age of 40 years, so most patients were in premenopausal status and menstrual status was strongly correlated with age. the probability of positive HER-2 expression was higher in PPBC patients (45%) than in controls, and 11 patients (27.5%) presented with TNBC, but it was not statistically significant. Among all known molecular subtypes of BC, TNBC had the worst prognosis. Most clinicopathological features did not differ significantly between groups in terms of parity (P > 0.05). In the entire cohort, younger patients were more likely to undergo BCS, but the overall breast-conservation rate was not high, at 4.8%. This may be related to the prevailing treatment setting and patient mindset. 90.2% of patients received anthracycline chemotherapy, the majority were IDC (69.3%), and the most common molecular subtype was HR(+)/HER-2(-) (44.3%).
3.2. Relationship between clinical factors and pCR in the maternal group
Table 2. Univariate analysis between clinical characteristics and pCR.
Patients characteristic
|
Postpartum patients
|
χ2
|
P
|
pCR(n=111)
|
NpCR(n=556)
|
N
|
%
|
N
|
%
|
Age
|
≤40
|
25
|
22.5
|
69
|
12.4
|
7.815
|
0.005
|
|
>40
|
86
|
77.5
|
487
|
87.6
|
|
|
Surgical methods
|
BCS
|
4
|
3.6
|
24
|
4.3
|
0.118
|
0.732
|
|
M
|
107
|
96.4
|
532
|
95.7
|
|
|
Menstruatio
|
Yes
|
57
|
51.3
|
277
|
49.8
|
0.087
|
0.768
|
|
No
|
54
|
48.7
|
279
|
50.2
|
|
|
BMI
|
≤18.5
|
1
|
0.9
|
14
|
2.5
|
3.566
|
0.312
|
|
18.5-24
|
53
|
47.7
|
230
|
41.3
|
|
|
|
24-30
|
48
|
43.2
|
279
|
50.2
|
|
|
|
≥30
|
9
|
8.2
|
33
|
6.0
|
|
|
Clinical T stage
|
1
|
22
|
19.8
|
58
|
10.4
|
8.736
|
0.013
|
|
2
|
76
|
68.5
|
402
|
72.3
|
|
|
|
3
|
13
|
11.7
|
96
|
17.3
|
|
|
Clinical N stage
|
0
|
24
|
21.6
|
66
|
11.9
|
10.216
|
0.017
|
|
1
|
60
|
54.1
|
292
|
52.5
|
|
|
|
2
|
9
|
8.1
|
75
|
13.5
|
|
|
|
3
|
18
|
16.2
|
123
|
22.1
|
|
|
Lymphatic infiltration
|
Yes
|
85
|
76.6
|
417
|
75.0
|
0.124
|
0.725
|
|
No
|
26
|
23.4
|
139
|
25.0
|
|
|
ER
|
Positive
|
34
|
30.6
|
332
|
59.7
|
31.602
|
<0.001
|
|
Negative
|
77
|
69.4
|
224
|
40.3
|
|
|
PR
|
Positive
|
23
|
20.7
|
266
|
47.8
|
27.717
|
<0.001
|
|
Negative
|
88
|
79.3
|
290
|
52.2
|
|
|
HER-2
|
Positive
|
61
|
55.0
|
189
|
34.0
|
17.351
|
<0.001
|
|
Negative
|
50
|
45.0
|
367
|
66.0
|
|
|
KI67
|
≤15
|
27
|
24.3
|
202
|
36.3
|
5.916
|
0.015
|
|
>15
|
84
|
75.7
|
354
|
63.7
|
|
|
P53
|
0
|
46
|
41.4
|
280
|
50.4
|
5.070
|
0.167
|
|
1
|
28
|
25.2
|
143
|
25.7
|
|
|
|
2
|
16
|
14.4
|
64
|
11.5
|
|
|
|
3
|
21
|
19.0
|
69
|
12.4
|
|
|
Histological type
|
IDC
|
7
|
6.3
|
460
|
82.7
|
466.983
|
<0.001
|
|
ILC
|
1
|
0.9
|
71
|
12.8
|
|
|
|
DCIS
|
19
|
17.1
|
2
|
0.3
|
|
|
|
Others
|
84
|
75.7
|
23
|
4.2
|
|
|
Chemotherapy regimen
|
Anthracycline-based
|
98
|
88.3
|
504
|
90.6
|
0.586
|
0.444
|
|
Other therapy
|
13
|
11.7
|
52
|
9.4
|
|
|
Histological grade
|
0-1
|
108
|
97.3
|
126
|
22.6
|
226.348
|
<0.001
|
|
2
|
3
|
2.7
|
349
|
62.8
|
|
|
|
3
|
0
|
0
|
81
|
14.6
|
|
|
Stage
|
I
|
3
|
2.7
|
9
|
1.6
|
11.253
|
0.004
|
|
II
|
78
|
70.3
|
302
|
54.3
|
|
|
|
III
|
30
|
27.0
|
245
|
44.1
|
|
|
Molecular subtype
|
HR+/HER-2+
|
14
|
12.6
|
63
|
11.3
|
37.211
|
<0.001
|
|
HR+/HER-2-
|
21
|
18.9
|
273
|
49.1
|
|
|
|
HR-/HER-2+
|
47
|
42.3
|
127
|
22.8
|
|
|
|
TNBC
|
29
|
26.2
|
93
|
16.8
|
|
|
Parity status
|
PPBC
|
15
|
13.5
|
25
|
4.5
|
13.345
|
<0.001
|
|
Parous>5
|
96
|
86.5
|
531
|
95.5
|
|
|
Bold values indicate that they are statistically significant at P ≤0.05
Table 3. Multivariate analysis between clinical characteristics and pCR.
Patients characteristic
|
B
|
S.E
|
Wals
|
OR
|
CI(95%)
|
P
|
Age
|
>40
|
Ref
|
|
|
|
|
|
|
≤40
|
0.411
|
0.357
|
1.325
|
1.509
|
0.749-3.040
|
0.250
|
Clinical T stage
|
3
|
Ref
|
|
|
|
|
|
|
1
|
0.904
|
0.495
|
3.335
|
2.468
|
0.936-6.509
|
0.067
|
|
2
|
0.139
|
0.416
|
0.111
|
0.870
|
0.385-1.968
|
0.739
|
ER
|
Positive
|
Ref
|
|
|
|
|
|
|
Negative
|
0.579
|
0.338
|
2.929
|
1.783
|
0.919-3.456
|
0.087
|
PR
|
Positive
|
Ref
|
|
|
|
|
|
|
Negative
|
0.649
|
0.375
|
2.989
|
1.914
|
0.917-3.995
|
0.084
|
HER-2
|
Negative
|
Ref
|
|
|
|
|
|
|
Positive
|
0.590
|
0.239
|
6.120
|
1.804
|
1.130-2.879
|
0.013
|
Parity status
|
Parous>5
|
Ref
|
|
|
|
|
|
|
PPBC
|
0.927
|
0.460
|
4.063
|
2.526
|
1.026-6.219
|
0.044
|
KI67
|
≤15
|
Ref
|
|
|
|
|
|
|
>15
|
0.449
|
0.261
|
2.952
|
1.567
|
0.939-2.616
|
0.086
|
Clinical N stage
|
3
|
Ref
|
|
|
|
|
|
|
0
|
0.026
|
0.705
|
0.001
|
1.027
|
0.258-4.084
|
0.970
|
|
1
|
0.705
|
0.623
|
1.280
|
0.494
|
0.146-1.676
|
0.258
|
|
2
|
0.206
|
0.462
|
0.199
|
0.814
|
0.329-2.013
|
0.655
|
Stage
|
III
|
Ref
|
|
|
|
|
|
|
I
|
0.157
|
1.081
|
0.021
|
1.170
|
0.141-9.747
|
0.884
|
|
II
|
1.364
|
0.629
|
4.693
|
3.910
|
1.139-13.426
|
0.030
|
Bold values indicate that they are statistically significant at P ≤0.05
Among patients who delivered, a total of 111 (16.6%) achieved pCR and 556 (83.4%) did not. Univariate analysis was used to determine the factors affecting the pCR rate after NAC. Age, T stage, N stage, ER expression, PR expression, HER-2 expression, KI67 expression, histological grade, molecular subtype, clinical stage, type of pathology, and time of delivery were all strongly associated with pCR rate (P < 0.05) (Table 2). However, there was no significant correlation between chemotherapy regimen, surgical mode, menopausal status, BMI, P53 expression, lymphatic infiltration, and pCR (P > 0.05). Patients with younger age, lower T- and N-stage, ER-negative, PR-negative, HER2-positive, high KI67 expression, and lower BC histological grade were more likely to achieve pCR.
Factors that were statistically significant in the univariate analysis were entered into the multifactorial analysis (both of which were excluded due to differences in histological grading and type of pathology that could affect the results), and logistic regression analysis showed that patients with PPBC were more likely to achieve PCR compared with those who had been in labor for more than 5 years (OR = 2.526, CL95% 1.026-6.219, P = 0.040). HER-2 positive patients were more likely to achieve pCR than negative ones (OR = 1.804,CI 95% 1.130-2.879, P = 0.013). These two factors were statistically significant. Delivery status and HER-2 expression were strongly associated with the performance of PCR in BC patients (P < 0.05) and were independent predictors of achieving postoperative PCR (Table 3).
3.3. Predictive analysis of patients obtaining pCR or NpCR
Table 4. Predictive analysis of KI67 and HER-2 expression affecting pCR
Patients characteristic
|
AUC
|
S.E
|
CI(95%)
|
P
|
HER-2
|
Negative
|
Ref
|
|
|
|
|
Positive
|
0.605
|
0.030
|
0.546-0.663
|
<0.001
|
KI67
|
≤15
|
Ref
|
|
|
|
|
>15
|
0.560
|
0.029
|
0.503-0.617
|
0.046
|
Bold values indicate that they are statistically significant at P ≤0.05
Table 5. Predictive analysis of Stage, Age and PR expression affecting NpCR
Patients characteristic
|
AUC
|
S.E
|
CI(95%)
|
P
|
Age
|
≤40
|
Ref
|
|
|
|
|
>40
|
0.551
|
0.031
|
0.489-0.612
|
0.092
|
Clinical T stage
|
1+2
|
Ref
|
|
|
|
|
3
|
0.564
|
0.030
|
0.504-0.623
|
0.034
|
ER
|
Negative
|
Ref
|
|
|
|
|
Positive
|
0.645
|
0.028
|
0590-0.701
|
<0.001
|
PR
|
Negative
|
Ref
|
|
|
|
|
Positive
|
0.636
|
0.027
|
0.583-0.689
|
<0.001
|
Clinical N stage
|
0
|
Ref
|
|
|
|
|
1, 2, 3
|
0.579
|
0.030
|
0.520-0.638
|
0.008
|
Parity status
|
PPBC
|
Ref
|
|
|
|
|
Parous>5
|
0.545
|
0.031
|
0.484-0.607
|
0.133
|
Stage
|
I
|
Ref
|
|
|
|
|
TT, III
|
0.587
|
0.029
|
0.531-0..643
|
0.004
|
Bold values indicate that they are statistically significant at P ≤0.05
We used receiver operating characteristic curve (ROC) to predict the probability of obtaining pCR in BC patients (Figure 3, Figure 4). The results revealed that the probability of obtaining pCR was 56.0% for KI67 > 15 patients and 60.5% for HER- 2-positive patients (Table 4), with statistically significant differences (P < 0.05). In addition, this study also found that when clinical T or N staging was high and ER or PR expression was positive, patients were less likely to achieve pCR, with probabilities of 56.4%, 57.9%, 64.5%, and 63.6%, respectively, with statistically significant differences (P < 0.05) (Table 5). We found that BC patients were not as likely to achieve pCR when women had been in labor for more than 5 years, but the difference was not statistically significant (P > 0.05).
3.4. Correlation between clinical factors and pCR in the PPBC and Parous>5 group
Table 6. Relationship with the clinical characteristics and pCR according to parous age group
Patients characteristic
|
Postpartum patients
|
χ2
|
P
|
pCR(n=111)
|
NpCR(n=556)
|
|
|
N
|
%
|
N
|
%
|
|
|
Age at diagnosis
|
≤40
|
PPBC
|
14
|
12.6
|
19
|
3.4
|
6.526
|
0.011
|
|
|
Parous>5
|
11
|
9.9
|
50
|
9.0
|
|
|
|
>40
|
PPBC
|
1
|
0.9
|
6
|
1.1
|
0.003
|
0.957
|
|
|
Parous>5
|
85
|
76.6
|
481
|
86.5
|
|
|
Menstruatio
|
Yes
|
PPBC
|
15
|
13.5
|
1
|
0.1
|
54.753
|
<0.001
|
|
|
Parous>5
|
57
|
51.3
|
276
|
49.6
|
|
|
|
No
|
PPBC
|
0
|
0
|
24
|
4.3
|
3.629
|
0.057
|
|
|
Parous>5
|
39
|
35.2
|
255
|
46.0
|
|
|
Surgical methods
|
BCS
|
PPBC
|
1
|
0.9
|
5
|
0.8
|
0.241
|
0.623
|
|
|
Parous>5
|
2
|
1.8
|
19
|
3.4
|
|
|
|
M
|
PPBC
|
14
|
12.6
|
20
|
3.6
|
15.117
|
<0.001
|
|
|
Parous>5
|
94
|
84.7
|
512
|
92.2
|
|
|
ER
|
Positive
|
PPBC
|
5
|
4.5
|
12
|
2.2
|
8.566
|
0.003
|
|
|
Parous>5
|
29
|
26.1
|
320
|
57.6
|
|
|
|
Negative
|
PPBC
|
10
|
9.0
|
13
|
2.3
|
4.190
|
0.041
|
|
|
Parous>5
|
67
|
60.4
|
211
|
37.9
|
|
|
PR
|
Positive
|
PPBC
|
5
|
4.5
|
11
|
2.0
|
12.544
|
<0.001
|
|
|
Parous>5
|
18
|
16.2
|
255
|
45.9
|
|
|
|
Negative
|
PPBC
|
10
|
9.0
|
14
|
2.5
|
4.851
|
0.028
|
|
|
Parous>5
|
78
|
70.3
|
276
|
49.6
|
|
|
HER-2
|
Positive
|
PPBC
|
7
|
6.3
|
11
|
2.0
|
3.989
|
0.046
|
|
|
Parous>5
|
42
|
37.8
|
178
|
32.0
|
|
|
|
Negative
|
PPBC
|
8
|
7.2
|
14
|
2.5
|
9.005
|
0.003
|
|
|
Parous>5
|
54
|
48.7
|
353
|
63.5
|
|
|
Lymphatic infiltration
|
Yes
|
PPBC
|
11
|
9.9
|
21
|
3.8
|
7.393
|
0.007
|
|
|
Parous>5
|
74
|
66.7
|
396
|
71.2
|
|
|
|
No
|
PPBC
|
4
|
3.6
|
4
|
0.7
|
7.426
|
0.006
|
|
|
Parous>5
|
22
|
19.8
|
135
|
24.3
|
|
|
Clinical T stage
|
1
|
PPBC
|
1
|
0.9
|
4
|
0.7
|
0.150
|
0.698
|
|
|
Parous>5
|
21
|
18.9
|
54
|
9.7
|
|
|
|
2
|
PPBC
|
9
|
8.1
|
17
|
3.1
|
7.203
|
0.007
|
|
|
Parous>5
|
67
|
60.3
|
385
|
69.2
|
|
|
|
3
|
PPBC
|
5
|
4.5
|
4
|
0.7
|
17.777
|
<0.001
|
|
|
Parous>5
|
8
|
7.3
|
92
|
16.6
|
|
|
Clinical N stage
|
0
|
PPBC
|
4
|
3.6
|
3
|
0.5
|
3.605
|
0.058
|
|
|
Parous>5
|
20
|
18.0
|
63
|
11.3
|
|
|
|
1
|
PPBC
|
6
|
5.4
|
14
|
2.5
|
2.517
|
0.113
|
|
|
Parous>5
|
54
|
48.7
|
278
|
50.0
|
|
|
|
2
|
PPBC
|
3
|
2.7
|
3
|
0.5
|
10.425
|
0.001
|
|
|
Parous>5
|
6
|
5.4
|
72
|
12.9
|
|
|
|
3
|
PPBC
|
2
|
1.8
|
5
|
0.9
|
1.652
|
0.199
|
|
|
Parous>5
|
16
|
14.4
|
118
|
21.4
|
|
|
KI67
|
≤15
|
PPBC
|
2
|
1.8
|
10
|
2.0
|
0.282
|
0.595
|
|
|
Parous>5
|
25
|
22.5
|
191
|
34.3
|
|
|
|
>15
|
PPBC
|
13
|
11.7
|
15
|
2.7
|
14.399
|
<0.001
|
|
|
Parous>5
|
71
|
64.0
|
340
|
61.0
|
|
|
P53
|
0
|
PPBC
|
5
|
4.5
|
1
|
0.1
|
22.806
|
<0.001
|
|
|
Parous>5
|
41
|
36.9
|
264
|
47.5
|
|
|
|
1
|
PPBC
|
5
|
4.5
|
2
|
0.4
|
15.643
|
<0.001
|
|
|
Parous>5
|
23
|
20.7
|
137
|
24.6
|
|
|
|
2
|
PPBC
|
3
|
2.7
|
16
|
2.9
|
0.019
|
0.891
|
|
|
Parous>5
|
13
|
11.7
|
63
|
11.3
|
|
|
|
3
|
PPBC
|
2
|
1.8
|
6
|
1.1
|
0.036
|
0.850
|
|
|
Parous>5
|
19
|
17.2
|
67
|
12.1
|
|
|
Chemotherapy regimen
|
Anthracycline-based
|
PPBC
|
13
|
11.7
|
21
|
3.8
|
12.746
|
<0.001
|
|
|
Parous>5
|
85
|
76.6
|
483
|
86.8
|
|
|
|
Other therapy
|
PPBC
|
2
|
1.8
|
4
|
0.7
|
0.734
|
0.391
|
|
|
Parous>5
|
11
|
9.9
|
48
|
8.7
|
|
|
Stage
|
I+II
|
PPBC
|
8
|
7.2
|
15
|
2.7
|
2.971
|
0.085
|
|
|
Parous>5
|
73
|
65.7
|
296
|
53.2
|
|
|
|
III
|
PPBC
|
7
|
6.3
|
10
|
1.8
|
17.080
|
<0.001
|
|
|
Parous>5
|
23
|
20.8
|
235
|
42.3
|
|
|
Molecular subtype
|
HR+/HER-2+
|
PPBC
|
1
|
0.9
|
5
|
0.9
|
0.010
|
0.920
|
|
|
Parous>5
|
13
|
11.7
|
58
|
10.4
|
|
|
|
HR+/HER-2-
|
PPBC
|
4
|
3.6
|
7
|
1.3
|
14.711
|
<0.001
|
|
|
Parous>5
|
17
|
15.3
|
266
|
47.8
|
|
|
|
HR-/HER-2+
|
PPBC
|
6
|
5.4
|
6
|
1.1
|
3.455
|
0.063
|
|
|
Parous>5
|
41
|
36.9
|
121
|
21.8
|
|
|
|
TNBC
|
PPBC
|
4
|
3.6
|
7
|
1.3
|
1.058
|
0.304
|
|
|
Parous>5
|
25
|
22.6
|
86
|
15.4
|
|
|
Bold values indicate that they are statistically significant at P ≤0.05
Table 7. Subgroup analysis of the PPBC group versus pCR
Patients characteristic
|
PPBC
|
pCR(PPBC vs.Other)
|
RR
|
P for interaction
|
N
|
n/N
|
(95%CI)
|
Lymphatic infiltration
|
Yes
|
32
|
11/32 vs. 74/470
|
2.183(1.295-3.681)
|
<0.001
|
|
No
|
8
|
4/8 vs. 22/157
|
3.568(1.613-7.893)
|
|
ER
|
Positive
|
17
|
5/17 vs. 29/349
|
3.540(1.567-7.994)
|
<0.001
|
|
Negative
|
23
|
10/23 vs. 67/278
|
1.804(1.083-3.006)
|
|
PR
|
Positive
|
16
|
5/16 vs. 18/273
|
4.740(2.020-11.122)
|
<0.001
|
|
Negative
|
24
|
10/24 vs. 78/354
|
1.891(1.133-3.156)
|
|
HER-2
|
Positive
|
18
|
7/18 vs. 42/220
|
2.037(1.074-3.863)
|
<0.001
|
|
Negative
|
22
|
8/22 vs. 54/407
|
2.741(1.495-5.024)
|
|
KI67
|
≤15
|
12
|
2/12 vs. 25/216
|
1.440(0.386-5.378)
|
<0.001
|
|
>15
|
28
|
13/28 vs. 71/411
|
2.688(1.713-4.218)
|
|
Age
|
≤40
|
33
|
14/33 vs. 11/61
|
2.353(1.208-4.582)
|
<0.001
|
|
>40
|
7
|
1/7 vs. 85/566
|
0.951(0.153-5.901)
|
|
Stage
|
I+II
|
23
|
8/15 vs. 73/369
|
2.696(1.609-4.517)
|
<0.001
|
|
III
|
17
|
7/17 vs. 23/258
|
4.619(2.319-9.201)
|
|
Bold values indicate that they are statistically significant at P ≤0.05
In the present study, we proceeded to analyze the pCR rates for clinicopathological features in the different delivery groups (Table 6). In the vast majority of cases, patients with PPBC were more likely to achieve pCR than those who had been in labor for more than 5 years, and this relationship was significant. We further analyzed the interaction between time to delivery and clinicopathological features of BC by general linear model (Table 7). patients with PPBC were associated with age, lymphatic infiltration, ER expression, PR expression, HER-2 expression, KI67 expression, p53 expression, and clinical stage, and RR values were calculated between subgroups (P < 0.001) (Figure 5). patients with PPBC were more likely to to reach pCR, a phenomenon that was only insignificant when BC patients were older.
3.5. Describe the patient's pCR according to the RECIST standard
Table 8. Group differences using RECIST as the pathological criteria
RECIST
|
Postpartum patients
|
P
|
PPBC(n=40)
|
Parous>5(n=627)
|
N
|
%
|
N
|
%
|
PD
|
2
|
5
|
9
|
1.4
|
0.001
|
SD
|
3
|
7.5
|
102
|
16.2
|
|
PR
|
20
|
50.0
|
420
|
66.9
|
|
CR
|
15
|
35.5
|
96
|
15.5
|
|
Bold values indicate that they are statistically significant at P ≤0.05
Clinical efficacy was evaluated according to the efficacy evaluation criteria of the solid tumor criteria (RECIST) version 1.1 (Table 8). Partial remission (PR) and complete remission (CR) were defined as good clinical response; progressive disease (PD) and stable lesions (SD) were defined as poor clinical response (Figure 6). PR rates were highest in both groups, 50.0% and 66.9%, respectively. The overall outcome of chemotherapy was good, with only 11 patients progressing without improvement after treatment with NAC. patients with PPBC were twice as likely to achieve CR (35.5% vs. 15.5%) and the difference was statistically significant (P < 0.05).
3.6. Effect of a history of abortion and lactation on pCR in BC patients
Table 9. Effect of other reproductive information on the pCR in BC patients
Patients characteristic
|
Parous patients
|
χ2
|
P
|
pCR(n=111)
|
NpCR(n=556)
|
|
|
N
|
%
|
N
|
%
|
|
|
Abortion
|
0
|
39
|
35.3
|
191
|
34.3
|
0.506
|
0.918
|
|
1
|
37
|
24.3
|
202
|
36.3
|
|
|
|
2
|
25
|
31.4
|
112
|
20.1
|
|
|
|
3
|
10
|
9.0
|
51
|
9.3
|
|
|
Lactation
|
0
|
8
|
7.2
|
47
|
8.5
|
11.708
|
0.008
|
|
1-12
|
34
|
30.6
|
218
|
39.2
|
|
|
|
13-24
|
57
|
51.4
|
192
|
34.3
|
|
|
|
>25
|
12
|
10.8
|
99
|
18.0
|
|
|
Parity
|
1
|
82
|
73.9
|
394
|
70.9
|
0.410
|
0.522
|
|
2
|
29
|
26.1
|
162
|
29.1
|
|
|
Bold values indicate that they are statistically significant at P ≤0.05
In the present study, we continued to analyze the effect of other reproductive histories on the pCR of BC patients (Table 9). A total of 437 patients experienced spontaneous or induced abortions. We found that abortion did not affect the response to chemotherapy in BC patients (P > 0.05). Only 55 of this group did not breastfeed their infants, and patients were categorized according to the duration of breastfeeding. When BC patients were breastfed for 13-24 months, patients were more likely to achieve pCR, and this correlation was significant (P < 0.05). In addition, the sensitivity to chemotherapy was similar in singleton and multiplex patients (P > 0.05).