Clinical and pathological predictors of recurrence in breast cancer patients achieving pathological complete response to neoadjuvant chemotherapy.

Autor: Asaoka M; Department of Breast Oncology and Surgery, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan; Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, 14263, USA., Narui K; Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, 4-57 Urafune, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan., Suganuma N; Department of Mammary Gland Endocrine Surgery, Kanagawa Cancer Center, 2-3-2 Nakano, Asahi-ku, Yokohama, Kanagawa, 241-8515, Japan., Chishima T; Department of Breast Surgery, Yokohama Rosai Hospital, 3211 Kozukue-Chō, Kōhoku-Ku, Yokohama, Kanagawa, 222-0036, Japan., Yamada A; Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, 4-57 Urafune, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan; Department of Gastroenterological Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan., Sugae S; Department of Gastroenterological Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan., Kawai S; Department of Breast Oncology and Surgery, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan., Uenaka N; Department of Breast Oncology and Surgery, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan., Teraoka S; Department of Breast Oncology and Surgery, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan., Miyahara K; Department of Breast Oncology and Surgery, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan., Kawate T; Department of Breast Oncology and Surgery, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan., Sato E; Department of Pathology, Institute of Medical Science (Medical Research Center, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan., Nagao T; Department of Pathology, Institute of Medical Science (Medical Research Center, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan., Matsubara Y; Department of Mammary Gland Endocrine Surgery, Kanagawa Cancer Center, 2-3-2 Nakano, Asahi-ku, Yokohama, Kanagawa, 241-8515, Japan., Gandhi S; Division of Breast Medicine, Department of Medicine, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, 14263, USA., Takabe K; Department of Breast Oncology and Surgery, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan; Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, 14263, USA., Ishikawa T; Department of Breast Oncology and Surgery, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan. Electronic address: tishik55@gmail.com.
Jazyk: angličtina
Zdroj: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology [Eur J Surg Oncol] 2019 Dec; Vol. 45 (12), pp. 2289-2294. Date of Electronic Publication: 2019 Aug 02.
DOI: 10.1016/j.ejso.2019.08.001
Abstrakt: Introduction: Despite the excellent prognosis associated with pathological complete response (pCR) to neoadjuvant chemotherapy (NAC), some patients still develop recurrence. Here, we investigated the outcomes of breast cancer patients with pCR, as well as the clinical and pathological predictors of cancer recurrence in these patients.
Materials and Methods: Of the 1599 breast cancer patients treated with NAC, we evaluated 394 patients who achieved pCR between January 2007 and December 2016. pCR was defined as no evidence of invasive cancer in breast. Residual in situ ductal and axillary lymph node diseases were not considered. We analyzed the outcomes using the Kaplan-Meier method. We assessed the association of clinical and pathological predictors with cancer recurrence using the cox proportional hazards regression model.
Results: The median follow-up time was 63 months. The 5-year disease-free survival rate was 92.3%. Cancer recurrence was observed in 28 patients (7.1%): local recurrence 8 patients (2.0%), visceral metastasis 10 patients (2.5%), and brain metastasis 10 patients (2.5%). Brain metastases were found in patients with HER2 type breast cancer. The significant predictors of cancer recurrence were HER2 positivity (p = 0.04), clinical tumor size (p < 0.01), and lymph node metastasis (p < 0.01) before NAC on univariate analysis and only lymph node metastasis on multivariate analysis.
Conclusion: Patients achieving pCR to NAC showed excellent outcomes. Advanced clinical stage, large tumor size, presence of lymph node metastasis, and HER2 positivity before NAC were identified as significant predictors of cancer recurrence. Residual in situ ductal and lymph node diseases after NAC were not significant predictors.
(Copyright © 2019 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)
Databáze: MEDLINE
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