Correlation of XIAP and Smac expression with pathological complete response and prognosis of axillary positive lymph nodes after neoadjuvant chemotherapy for breast cancer
Objective To investigate the correlation between the expression of X-linked apoptosis suppressor protein(XIAP)and the second mitochondria-derived cysteine protease activator(Smac)and pathologic complete response(pCR)of axillary lymph node(ALN)positive and prognosis of breast cancer after neoadjuvant chemotherapy(NACT).Methods A total of 195 patients with ALN positive breast cancer admitted to our hospital from June 2019 to June 2021 were included in the breast cancer group.All patients underwent NACT,and all patients underwent biopsy before NACT to obtain lesion tissue.In the same period,195 patients with benign breast nodules confirmed by pathology were selected and included in the control group.The expression levels of XIAP and Smac were detected by immunohisto-chemistry.Breast cancer patients were divided into pCR group and non-PCR group according to NACT efficacy,and clinical data of patients were collected.Univariate and multivariate Logistic regression models were used to analyze the non-PCR influencing factors in ALN-positive patients after NACT.Kaplan Meier method was used to analyze the sur-vival and prognosis of patients with different XIAP and Smac expressions.Results The low expression of XIAP in breast cancer group was lower than that in control group,and the low expression of Smac was higher than that in con-trol group(P＜0.05).Among the 195 patients,72 patients had post-NACT pCR,and the incidence of pCR was 36.92％.The proportion of AJCC Ⅲ stage,primary lesion diameter＞3.5 cm,number of ALN≥4,ALN pN1～pN2 stage,high XIAP expression and low Smac expression in non-PCR group were higher than those in pCR group(P＜0.05).Logistic regression analysis model showed that AJCC stage Ⅲ,ALN number ≥4,ALN pN1～pN2 stage,high XIAP expression and low Smac expression were independent non-PCR risk factors for positive ALN after NACT in breast cancer patients(P＜0.05,OR＞1).Patients were followed up for 12 to 36 months,with a median follow-up time of 26 months.Kaplan Meier survival analysis showed that the 3-year cumulative survival rate of patients with low XIAP expression was 94.9％,which was higher than that of patients with high XIAP expression(Log rank x2=4.931,P=0.026).The 3-year cumulative survival rate was 89.8％in patients with low Smac expression,which was lower than 94.0％in patients with high Smac expression(Log rank x2=4.534,P=0.033).Conclusion XIAP expression is abnor-mally high and Smac expression is abnormally low in tissues of ALN-positive breast cancer patients.High XIAP expres-sion and low Smac expression are independent non-PCR risk factors for ALN-positive breast cancer patients after NACT.Patients with low XIAP expression and high Smac expression have higher survival rate and better prognosis.
Breast cancerInhibiting X-linked apoptosis suppressor proteinA second mitochondrial derived cysteine protease activatorNeoadjuvant chemotherapyAxillary lymph nodes were positiveprognosis
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NSTL
维普
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