Sebastian Diaz-Botero1, Martin Espinosa-Bravo1, Victor Rodrigues Gonçalves1, Antonio Esgueva-Colmenarejo1, Vicente Peg2, Jose Perez3,4, Javier Cortes5,4, Isabel T Rubio6. 1. Breast Surgical Oncology Unit, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain. 2. Pathology Department, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain. 3. Department of Medical Oncology, Hospital Universitario Vall d'Hebron, Barcelona, Spain. 4. Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain. 5. Department of Medical Oncology, Hospital Universitario Ramón y Cajal, Madrid, Spain. 6. Breast Surgical Oncology Unit, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain. irubio@vhio.net.
Abstract
BACKGROUND: Pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) can be used as an independent prognostic factor in neoadjuvant trials. The objective of this study was to determine the impact of Ki 67 expression and site of response on overall survival (OS) and disease-free survival (DFS) across different molecular subtypes of breast cancer following NAC. METHODS: Records from 357 patients who received NAC from 2004 to 2011 were reviewed. Univariate and multivariate analyses were performed to analyze clinical and pathological factors that influence pCR and DFS. RESULTS: Mean follow-up time was 45 months (range 12-112). pCR was achieved in 82 patients (23 %). According to molecular subtypes, rates of pCR were significantly higher for patients with HER2-positive and triple-negative tumors (69.4 and 32.7 %, respectively; p < 0.001) compared with other molecular subtypes. pCR was a predictive factor of longer OS and DFS. The hazard ratio for DFS in patients with positive lymph nodes (ypN1) after NAC was 2.48 (95 % confidence interval 1.47-4.19). Multivariate analysis showed that molecular subtype, changes in Ki 67 expression, and axillary lymph node response were significantly predictors of OS and DFS. CONCLUSIONS: pCR in the axilla and posttreatment changes in Ki 67 after NAC are associated with improved survival. Depending on axillary staging before NAC, detection of minimal residual disease-defined as the presence of isolated tumor cells in the SLN after NAC-may confer different prognosis. Further studies are needed to tailor treatments for patients with residual disease after NAC.
BACKGROUND: Pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) can be used as an independent prognostic factor in neoadjuvant trials. The objective of this study was to determine the impact of Ki 67 expression and site of response on overall survival (OS) and disease-free survival (DFS) across different molecular subtypes of breast cancer following NAC. METHODS: Records from 357 patients who received NAC from 2004 to 2011 were reviewed. Univariate and multivariate analyses were performed to analyze clinical and pathological factors that influence pCR and DFS. RESULTS: Mean follow-up time was 45 months (range 12-112). pCR was achieved in 82 patients (23 %). According to molecular subtypes, rates of pCR were significantly higher for patients with HER2-positive and triple-negative tumors (69.4 and 32.7 %, respectively; p < 0.001) compared with other molecular subtypes. pCR was a predictive factor of longer OS and DFS. The hazard ratio for DFS in patients with positive lymph nodes (ypN1) after NAC was 2.48 (95 % confidence interval 1.47-4.19). Multivariate analysis showed that molecular subtype, changes in Ki 67 expression, and axillary lymph node response were significantly predictors of OS and DFS. CONCLUSIONS: pCR in the axilla and posttreatment changes in Ki 67 after NAC are associated with improved survival. Depending on axillary staging before NAC, detection of minimal residual disease-defined as the presence of isolated tumor cells in the SLN after NAC-may confer different prognosis. Further studies are needed to tailor treatments for patients with residual disease after NAC.
Authors: Ramon Colomer; Cristina Saura; Pedro Sánchez-Rovira; Tomás Pascual; Isabel T Rubio; Octavio Burgués; Lourdes Marcos; César A Rodríguez; Miguel Martín; Ana Lluch Journal: Oncologist Date: 2019-02-01
Authors: Paula Cabrera-Galeana; Wendy Muñoz-Montaño; Fernando Lara-Medina; Alberto Alvarado-Miranda; Victor Pérez-Sánchez; Cynthia Villarreal-Garza; R Marisol Quintero; Fany Porras-Reyes; Enrique Bargallo-Rocha; Ignacio Del Carmen; Alejandro Mohar; Oscar Arrieta Journal: Oncologist Date: 2018-02-28
Authors: Eugeni Lopez-Bonet; Maria Buxó; Elisabet Cuyàs; Sonia Pernas; Joan Dorca; Isabel Álvarez; Susana Martínez; Jose Manuel Pérez-Garcia; Norberto Batista-López; César A Rodríguez-Sánchez; Kepa Amillano; Severina Domínguez; Maria Luque; Idoia Morilla; Agostina Stradella; Gemma Viñas; Javier Cortés; Gloria Oliveras; Cristina Meléndez; Laura Castillo; Sara Verdura; Joan Brunet; Jorge Joven; Margarita Garcia; Samiha Saidani; Begoña Martin-Castillo; Javier A Menendez Journal: J Clin Med Date: 2019-12-11 Impact factor: 4.241