Frederik Marmé1, Bianca Lederer2, Jens-Uwe Blohmer3, Serban Dan Costa4, Carsten Denkert5, Holger Eidtmann6, Bernd Gerber7, Claus Hanusch8, Jörn Hilfrich9, Jens Huober10, Christian Jackisch11, Sherko Kümmel12, Sibylle Loibl2, Stefan Paepke13, Michael Untch14, Gunter von Minckwitz2, Andreas Schneeweiss15. 1. Nationales Centrum für Tumorerkrankungen (NCT), Heidelberg, Im Neuenheimer Feld 460, 69120 Heidelberg, Germany; Universitäts-Frauenklinik Heidelberg, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany. Electronic address: frederik.marme@med.uni-heidelberg.de. 2. German Breast Group (GBG) Forschungs GmbH, Martin Behaim Strasse 12, 63263 Neu-Isenburg, Germany. 3. Sankt Gertrauden Krankenhaus, Paretzer Straße 12, 10713 Berlin, Germany. 4. Universitäts-Frauenklinik Magdeburg, Gerhart-Hauptmann-Straße 35, 39108 Magdeburg, Germany. 5. Institute of Pathology, Charité-Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany. 6. Universitäts-Frauenklinik Kiel, Michaelisstraße 16, 24105 Kiel, Germany. 7. Universitäts-Frauenklinik Rostock, Südring 81, 18059 Rostock, Germany. 8. Klinikum zum Roten Kreuz, Nymphenburger Straße 163, 80634 München, Germany. 9. Eilenriede Krankenhaus, Uhlemeyerstraße 16, 30175 Hannover, Germany. 10. Universitäts-Frauenklinik Ulm, Prittwitzstraße 43, 89081 Ulm, Germany. 11. Klinikum Offenbach, Starkenburgring 66, 63069 Offenbach, Germany. 12. Brustzentrum, Kliniken Essen-Mitte, Henricistr. 92, 45136 Essen, Germany. 13. Universitäts-Frauenklinik rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 München, Germany. 14. Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125 Berlin, Germany. 15. Nationales Centrum für Tumorerkrankungen (NCT), Heidelberg, Im Neuenheimer Feld 460, 69120 Heidelberg, Germany; Universitäts-Frauenklinik Heidelberg, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany.
Abstract
BACKGROUND: Pathologic complete response after neoadjuvant chemotherapy (NACT) correlates with overall survival (OS) in primary breast cancer. A recently described staging system based on pre-treatment clinical stage (CS), final pathological stage (PS), estrogen receptor (ER) status and nuclear grade (NG) leads to a refined estimation of prognosis in unselected patients. Its performance in luminal type breast cancers has not been determined. This study investigates the clinical utility of this CPS+EG score when restricted to hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) patients and compares the results to a cohort of unselected patients. METHODS: The CPS+EG score was calculated for 6637 unselected patients and 2454 patients with HR+/HER2- tumours who received anthracycline/taxane-based NACT within 8 prospective German trials. RESULTS: Five-year disease-free survival (DFS) and OS were 75.6% and 84.1% for the unselected cohort and 80.6% and 87.8% for the HR+/HER2- subgroup, respectively. The CPS+EG system distinguished different prognostic groups with 5-year DFS ranging from 0% to 91%. The CPS+EG system leads to an improved categorisation of patients by outcome compared to CS, PS, ER or NG alone. When applying the CPS+EG score to the HR+/HER2- subgroup, a shift to lower scores was observed compared to the overall population, but 5-year DFS and OS for the individual scores were identical to that observed in the overall population. CONCLUSIONS: In HR+/HER2- patients, the CPS+EG staging system retains its ability to facilitate a refined stratification of patients according to outcome. It can help to select candidates for post-neoadjuvant clinical trials in luminal breast cancer.
BACKGROUND: Pathologic complete response after neoadjuvant chemotherapy (NACT) correlates with overall survival (OS) in primary breast cancer. A recently described staging system based on pre-treatment clinical stage (CS), final pathological stage (PS), estrogen receptor (ER) status and nuclear grade (NG) leads to a refined estimation of prognosis in unselected patients. Its performance in luminal type breast cancers has not been determined. This study investigates the clinical utility of this CPS+EG score when restricted to hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) patients and compares the results to a cohort of unselected patients. METHODS: The CPS+EG score was calculated for 6637 unselected patients and 2454 patients with HR+/HER2- tumours who received anthracycline/taxane-based NACT within 8 prospective German trials. RESULTS: Five-year disease-free survival (DFS) and OS were 75.6% and 84.1% for the unselected cohort and 80.6% and 87.8% for the HR+/HER2- subgroup, respectively. The CPS+EG system distinguished different prognostic groups with 5-year DFS ranging from 0% to 91%. The CPS+EG system leads to an improved categorisation of patients by outcome compared to CS, PS, ER or NG alone. When applying the CPS+EG score to the HR+/HER2- subgroup, a shift to lower scores was observed compared to the overall population, but 5-year DFS and OS for the individual scores were identical to that observed in the overall population. CONCLUSIONS: In HR+/HER2- patients, the CPS+EG staging system retains its ability to facilitate a refined stratification of patients according to outcome. It can help to select candidates for post-neoadjuvant clinical trials in luminal breast cancer.
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