Prognostic significance of subtype and pathologic response in operable breast cancer; a pooled analysis of prospective neoadjuvant studies of JBCRG

• Published in: Breast cancer (Tokyo, Japan) Vol. 22; no. 5; pp. 486 - 495
• Main Authors: Kuroi, Katsumasa, Toi, Masakazu, Ohno, Shinji, Nakamura, Seigo, Iwata, Hiroji, Masuda, Norikazu, Sato, Nobuaki, Tsuda, Hitoshi, Kurosumi, Masafumi, Akiyama, Futoshi
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.09.2015; Springer
• Subjects: Adjuvant treatment; Adult; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Breast cancer; Breast Neoplasms - drug therapy; Breast Neoplasms - mortality; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Cancer; Cancer Research; Cyclophosphamide; Cyclophosphamide - administration & dosage; Disease-Free Survival; Epirubicin - administration & dosage; Female; Fluorouracil - administration & dosage; Humans; Medical colleges; Medicine; Medicine & Public Health; Middle Aged; Neoadjuvant Therapy; Oncology; Oncology, Experimental; Original Article; Prognosis; Prospective Studies; Receptor, ErbB-2 - metabolism; Receptors, Estrogen - metabolism; Receptors, Progesterone - metabolism; Surgery; Surgical Oncology; Taxoids - administration & dosage; Treatment Outcome; Young Adult; Neoadjuvant chemotherapy; Pathologic response; Taxane; Anthracycline; Subtype
• ISSN: 1340-6868; 1880-4233
• DOI: 10.1007/s12282-013-0511-1

Purpose In the past decade, JBCRG has conducted three studies of neoadjuvant chemotherapy which have examined sequential combination of fluorouracil, epirubicin and cyclophosphamide, and docetaxel. The present study is a pooled analysis of these studies performed to determine the prognostic significance of pathologic complete response (pCR) and predictive variables for pCR. Methods A total of 353 patients were included. pCR was defined as the absence of invasive cancer or only a few remaining isolated cancer cells in the breast (quasi-pCR, QpCR). Results Disease-free survival (DFS) and overall survival (OS) were not significantly different among studies, and patients who achieved a QpCR had significantly better prognosis (DFS, p  < 0.001; OS, p  = 0.002). Patients with triple-negative (TN) tumors had worse prognosis than patients with the other subtypes (DFS, p  = 0.03; OS, p  = 0.10). A Cox proportional hazards model showed node-positive, TN, and QpCR were the significant predictors for DFS and OS among study, age, tumor size, nuclear grade, nodal status, subtype, clinical response, and pathologic response (DFS; node-positive, HR = 2.29, p  = 0.001; TN, HR = 3.39, p  < 0.001; QpCR, HR = 0.27, p  < 0.001: OS; node-positive, HR = 3.05, p  = 0.003; TN, HR = 4.92, p  < 0.001; QpCR, HR = 0.12, p  < 0.001). In a logistic regression analysis, subtype and clinical response before surgery were the significant predictive variables for QpCR (luminal/Her2-positive, odds ratio (OR) = 4.15, p  = 0.002; Her2-positive, OR = 6.24, p  < 0.001; TN, OR = 4.24, p  < 0.001; clinical response before surgery, OR = 2.41, p  = 0.019). Conclusions This study confirmed the prognostic significance of QpCR and nodal status and the predictive and prognostic significance of subtype in neoadjuvant chemotherapy.