Retrospective analysis of 119 Chinese noninflammatory locally advanced breast cancer cases treated with intravenous combination of vinorelbine and epirubicin as a neoadjuvant chemotherapy: a median follow-up of 63.4 months

• Published in: BMC cancer Vol. 9; no. 1; p. 375
• Main Authors: Huang, Ou, Chen, Canming, Wu, Jiayi, Chen, Shujie, Chen, Xiaosong, Liu, Guangyu, Hu, Zhen, Lu, Jingsong, Wu, Jiong, Shao, Zhimin, Shen, Zhenzhou, Shen, Kunwei
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 21.10.2009; BioMed Central; BMC
• Subjects: Adult; Aged; Analysis; Breast cancer; Breast Neoplasms - drug therapy; Breast Neoplasms - genetics; Breast Neoplasms - metabolism; Breast Neoplasms - pathology; Cancer therapies; Care and treatment; Chemotherapy; Chemotherapy, Combination; China; Diagnosis; Drug therapy; Drug Therapy, Combination; Epidermal growth factor; Epirubicin - administration & dosage; Female; Follow-Up Studies; Genetic aspects; Health aspects; Hospitalization; Hospitals; Humans; Infusions, Intravenous; Ki-67 Antigen - genetics; Ki-67 Antigen - metabolism; Middle Aged; Multivariate analysis; Neoadjuvant Therapy; Receptors, Estrogen - genetics; Receptors, Estrogen - metabolism; Retrospective Studies; Review boards; Surgery; Treatment Outcome; Vinblastine - administration & dosage; Vinblastine - analogs & derivatives; Young Adult; China
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/1471-2407-9-375

This study is a retrospective evaluation of the efficacy of neoadjuvant chemotherapy (NC) with a vinorelbine (V) and epirubicin (E) intravenous combination regimen and is aimed at identification of predictive markers for the long-term outcome in noninflammatory locally advanced breast cancer (NLABC). One-hundred-and-nineteen patients with NLABC were identified from September 2001 to May 2006. Analysis was performed in March 2008, with a median follow-up of 63.4 months (range, 9-76 months). All patients were diagnosed with invasive breast cancer using 14 G core needle biopsy and treated with three cycles of VE before surgery. Local-regional radiotherapy was offered to all patients after the completion of chemotherapy followed by hormonal therapy according to hormone receptor status. Tissue sections cut from formalin-fixed paraffin-embedded blocks from biopsy specimens and postoperative tumor tissues were stained for the presence of estrogen receptor (ER), progesterone receptor (PgR), HER-2 (human epidermal growth factor receptor-2), and MIB-1(Ki-67). Patients characteristics were median age 52 years (range: 25-70 years); clinical TNM stage, stage IIB (n = 32), stage IIIA (n = 56), stage IIIB (n = 22) and stage IIIC (n = 9). All patients were evaluable for response: clinically complete response was documented in 27 patients (22.7%); 78 (65.6%) obtained partial response; stable disease was observed in 13 (10.9%); 1 patient (0.8%) had progressive disease. Pathological complete response was found in 22 cases (18.5%). Seventy-five patients were alive with no recurrence after a median follow-up of 63.4 months, the 5-year rates for disease-free survival and overall survival were 58.7% and 71.3%, respectively, after the start of NC. On multivariate analysis, the independent variables associated with increased risk of relapse and death were high pre-Ki-67(p = 0.012, p = 0.017, respectively), high post-Ki-67 expression (p = 0.045, p = 0.001, respectively), and non-pCR (p = 0.034, p = 0.027, respectively). A significantly increased risk of death was associated with lack of pre-ER expression (p = 0.002). Among patients with non-pCR, those with a pathological response at the tumor site with special involvement (i.e. skin, vessel and more than one quadrant) were at a higher risk of disease relapse and death (p < 0.001, p = 0.001, respectively). This study suggests the promising use of a VE regimen as NC for Chinese NLABC after a median follow-up of 63.4 months. Pathological response in the tumor site, pre-Ki-67 and post-Ki-67 expression, and pre-ER expression were the important variables that predicted long-term outcome. Patients with pathological special involvement at the primary site after NC had the lowest survival rates.