Anne-Sophie Hamy1, Giang-Thanh Lam2,3, Enora Laas2, Lauren Darrigues2, Thomas Balezeau4, Julien Guerin4, Alain Livartowski4,5, Benjamin Sadacca1, Jean-Yves Pierga5, Anne Vincent-Salomon6, Florence Coussy7, Veronique Becette8, Hélène Bonsang-Kitzis2, Roman Rouzier9,10, Jean-Guillaume Feron2, Gabriel Benchimol2, Marick Laé6, Fabien Reyal11,12. 1. Translational Research Department, INSERM, U932, Immunity and Cancer, Residual Tumor & Response to Treatment Laboratory, RT2Lab, Institut Curie, PSL Research University, 26, rue d'Ulm, 75248, Paris, France. 2. Department of Surgery, Institut Curie, PSL Research University, 26 rue d'Ulm, 75248, Paris, France. 3. Department of Gynecology and Obstetrics, Geneva University Hospitals, 30 bd de la Cluse, 1205, Geneva, Switzerland. 4. Department of Medical Informatics and Data, Institut Curie, PSL Research University, 26 rue d'Ulm, 75248, Paris, France. 5. Department of Medical Oncology, Institut Curie, PSL Research University, 26 rue d'Ulm, 75248, Paris, France. 6. Department of Pathology, Institut Curie, PSL Research University, 26 rue d'Ulm, 75248, Paris, France. 7. Department of Medical Oncology, Hôpital René Huguenin, 35, rue Dailly, 92210, Saint-Cloud, France. 8. Department of Pathology, Hôpital René Huguenin, 35, rue Dailly, 92210, Saint-Cloud, France. 9. Department of Surgery, Hôpital René Huguenin, 35, rue Dailly, 92210, Saint-Cloud, France. 10. Equipe d'Accueil 7285, Risk and Safety in Clinical Medicine for Women and Perinatal Health, University Versailles-Saint-Quentin, 2 av de la source de la Bièvre, 78180, Montigny-Le-Bretonneux, France. 11. Translational Research Department, INSERM, U932, Immunity and Cancer, Residual Tumor & Response to Treatment Laboratory, RT2Lab, Institut Curie, PSL Research University, 26, rue d'Ulm, 75248, Paris, France. fabien.reyal@curie.fr. 12. Department of Surgery, Institut Curie, PSL Research University, 26 rue d'Ulm, 75248, Paris, France. fabien.reyal@curie.fr.
Abstract
PURPOSE: Few studies evaluated the prognostic value of the presence of lymphovascular invasion (LVI) after neoadjuvant chemotherapy (NAC) for breast cancer (BC). METHODS: The association between LVI and survival was evaluated in a cohort of BC patients treated by NAC between 2002 and 2011. Five post-NAC prognostic scores (ypAJCC, RCB, CPS, CPS + EG and Neo-Bioscore) were evaluated and compared with or without the addition of LVI. RESULTS: Out of 1033 tumors, LVI was present on surgical specimens in 29.2% and absent in 70.8% of the cases. Post-NAC LVI was associated with impaired disease-free survival (DFS) (HR 2.54; 95% CI 1.96-3.31; P < 0.001), and the magnitude of this effect depended on BC subtype (Pinteraction = 0.003), (luminal BC: HR 1.83; P = 0.003; triple negative BC: HR 3.73; P < 0.001; HER2-positive BC: HR 6.21; P < 0.001). Post-NAC LVI was an independent predictor of local relapse, distant metastasis, and overall survival; and increased the accuracy of all five post-NAC prognostic scoring systems. CONCLUSIONS: Post-NAC LVI is a strong independent prognostic factor that: (i) should be systematically reported in pathology reports; (ii) should be used as stratification factor after NAC to propose inclusion in second-line trials or adjuvant treatment; (iii) should be included in post-NAC scoring systems.
PURPOSE: Few studies evaluated the prognostic value of the presence of lymphovascular invasion (LVI) after neoadjuvant chemotherapy (NAC) for breast cancer (BC). METHODS: The association between LVI and survival was evaluated in a cohort of BC patients treated by NAC between 2002 and 2011. Five post-NAC prognostic scores (ypAJCC, RCB, CPS, CPS + EG and Neo-Bioscore) were evaluated and compared with or without the addition of LVI. RESULTS: Out of 1033 tumors, LVI was present on surgical specimens in 29.2% and absent in 70.8% of the cases. Post-NACLVI was associated with impaired disease-free survival (DFS) (HR 2.54; 95% CI 1.96-3.31; P < 0.001), and the magnitude of this effect depended on BC subtype (Pinteraction = 0.003), (luminal BC: HR 1.83; P = 0.003; triple negative BC: HR 3.73; P < 0.001; HER2-positive BC: HR 6.21; P < 0.001). Post-NACLVI was an independent predictor of local relapse, distant metastasis, and overall survival; and increased the accuracy of all five post-NAC prognostic scoring systems. CONCLUSIONS: Post-NACLVI is a strong independent prognostic factor that: (i) should be systematically reported in pathology reports; (ii) should be used as stratification factor after NAC to propose inclusion in second-line trials or adjuvant treatment; (iii) should be included in post-NAC scoring systems.
Entities:
Keywords:
Breast carcinoma; Lymphovascular invasion; Neoadjuvant chemotherapy; Prognostic scores
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