Radiologic complete response (rCR) in contrast-enhanced magnetic resonance imaging (CE-MRI) after neoadjuvant chemotherapy for early breast cancer predicts recurrence-free survival but not pathologic complete response (pCR)
| Autor: | Christian Weismann, Richard Greil, Cornelia Hauser-Kronberger, Brigitte Mlineritsch, Simon Peter Gampenrieder, Matthias Meissnitzer, Heike Egger, Katharina Stering, Gabriel Rinnerthaler, Frederike Klaassen Federspiel, Klaus Hergan, Theresa Westphal, Roland Reitsamer, Andreas Peer, Thomas Meissnitzer, Marina Riedmann, Johanna Webhofer |
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| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Neoplasm
Residual Survival medicine.medical_treatment Contrast Media Kaplan-Meier Estimate Gastroenterology 0302 clinical medicine Breast cancer Surgical oncology Antineoplastic Combined Chemotherapy Protocols Breast Complete response Mastectomy Aged 80 and over Prediction of complete pathologic response Middle Aged Prognosis lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens Magnetic Resonance Imaging Neoadjuvant Therapy medicine.anatomical_structure 030220 oncology & carcinogenesis Preoperative Period Female Research Article MRI Adult medicine.medical_specialty Concordance Breast surgery Breast Neoplasms Neoadjuvant chemotherapy lcsh:RC254-282 Disease-Free Survival 03 medical and health sciences Young Adult Predictive Value of Tests Internal medicine medicine Humans Aged Retrospective Studies Chemotherapy business.industry medicine.disease Axilla Neoplasm Recurrence Local business Kappa Follow-Up Studies |
| Zdroj: | Breast Cancer Research, Vol 21, Iss 1, Pp 1-11 (2019) Breast Cancer Research : BCR |
| DOI: | 10.1186/s13058-018-1091-y |
| Popis: | Background Patients with early breast cancer (EBC) achieving pathologic complete response (pCR) after neoadjuvant chemotherapy (NACT) have a favorable prognosis. Breast surgery might be avoided in patients in whom the presence of residual tumor can be ruled out with high confidence. Here, we investigated the diagnostic accuracy of contrast-enhanced MRI (CE-MRI) in predicting pCR and long-term outcome after NACT. Methods Patients with EBC, including patients with locally advanced disease, who had undergone CE-MRI after NACT, were retrospectively analyzed (n = 246). Three radiologists, blinded to clinicopathologic data, reevaluated all MRI scans regarding to the absence (radiologic complete remission; rCR) or presence (no-rCR) of residual contrast enhancement. Clinical and pathologic responses were compared categorically using Cohen’s kappa statistic. The Kaplan-Meier method was used to estimate recurrence-free survival (RFS) and overall survival (OS). Results Overall rCR and pCR (no invasive tumor in the breast and axilla (ypT0/is N0)) rates were 45% (111/246) and 29% (71/246), respectively. Only 48% (53/111; 95% CI 38–57%) of rCR corresponded to a pCR (= positive predictive value - PPV). Conversely, in 87% (117/135; 95% CI 79–92%) of patients, residual tumor observed on MRI was pathologically confirmed (= negative predictive value - NPV). Sensitivity to detect a pCR was 75% (53/71; 95% CI 63–84%), while specificity to detect residual tumor and accuracy were 67% (117/175; 95% CI 59–74%) and 69% (170/246; 95% CI 63–75%), respectively. The PPV was significantly lower in hormone-receptor (HR)-positive compared to HR-negative tumors (17/52 = 33% vs. 36/59 = 61%; P = 0.004). The concordance between rCR and pCR was low (Cohen’s kappa − 0.1), however in multivariate analysis both assessments were significantly associated with RFS (rCR P = 0.037; pCR P = 0.033) and OS (rCR P = 0.033; pCR P = 0.043). Conclusion Preoperative CE-MRI did not accurately predict pCR after NACT for EBC, especially not in HR-positive tumors. However, rCR was strongly associated with favorable RFS and OS. Electronic supplementary material The online version of this article (10.1186/s13058-018-1091-y) contains supplementary material, which is available to authorized users. |
| Databáze: | OpenAIRE |
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