Gustavo Werutsky1, Michael Untch2, Claus Hanusch3, Peter A Fasching4, Jens-Uwe Blohmer5, Sabine Seiler6, Carsten Denkert7, Hans Tesch8, Christian Jackisch9, Bernd Gerber10, Andreas Schneeweiss11, Theresa Link12, David Krug13, Jens Huober14, Kerstin Rhiem15, Thorsten Kühn16, Valentina Vladimirova6, Valentina Nekljudova6, Sibylle Loibl17. 1. German Breast Group Neu-Isenburg, Germany; Latin American Cooperative Oncology Group (LACOG) Porto Alegre, Brazil. 2. Helios-Klinikum Berlin-Buch, Germany. 3. Klinikum Zum Roten Kreuz München, Germany. 4. Universitäts-Frauenklinik Erlangen, Germany. 5. Brustzentrum Charité-Universitätsmedizin, Berlin, Germany. 6. German Breast Group Neu-Isenburg, Germany. 7. Institut für Pathologie UKGM-Universitätsklinikum Marburg, Germany. 8. Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany. 9. Sana Klinikum Offenbach, Germany. 10. Universitäts-Frauenklinik Rostock, Germany. 11. Nationales Centrum für Tumorerkrankungen, Universitätsklinikum und Deutsches Krebsforschungszentrum, Heidelberg, Germany. 12. Universitätsklinikum Dresden, Germany. 13. Universitätsklinikum Schleswig-Holstein, Klinik für Strahlentherapie, Kiel, Germany. 14. Department of Gynecology, University Hospital, Ulm, Germany. 15. Zentrum Familiärer Brust- und Eierstockkrebs Uniklinik Köln, Germany. 16. Klinikum Esslingen, Esslingen, Germany. 17. German Breast Group Neu-Isenburg, Germany. Electronic address: sibylle.loibl@GBG.de.
Abstract
AIM: This pooled analysis aimed to evaluate locoregional recurrence (LRR) rates of breast cancer (BC) after neoadjuvant chemotherapy (NACT) and to identify independent LRR predictors. METHODS: 10,075 women with primary BC from nine neoadjuvant trials were included. The primary outcome was the cumulative incidence rate of LRR as the first event after NACT. Distant recurrence, secondary malignancy or death were defined as competing events. For identifying LRR predictors, surgery type, pathological complete response (pCR), BC subtypes and other potential risk factors were evaluated. RESULTS: Median followup was 67 months (range 0-215), overall LRR rate was 9.5%, 4.1% in pCR versus 9.5% in non-pCR patients. Younger age, clinically positive lymph nodes, G3 tumours, non-pCR and TNBC but not surgery type were independent LRR predictors in multivariate analysis. Among BC subtypes, 5-year cumulative LRR rates were associated with higher risk in non-pCR versus pCR patients, which was significant for HR+/HER2- (5.9% vs 3.9%; HR = 2.32 [95%CI 1.22-4.43]; p = 0.011); HR-/HER2+ (14.8% vs 3.1%; HR = 4.26 [94%CI 2.35-7.71]; p < 0.001) and TNBC (18.5% vs 4.2%; HR = 4.10 [95%CI 2.88-5.82]; p < 0.001) but not for HR+/HER2+ (8.1% vs 4.8%; HR = 1.56 [95%CI 0.85-2.85]; p = 0.150). Within non-pCR subgroup, LRR risk was higher for HR-/HER2+ and TNBC vs HR+/HER2- (HR = 2.05 [95%CI 1.54-2.73]; p < 0.001 and HR = 2.77 [95%CI 2.27-3.39]; p < 0.001, respectively). CONCLUSIONS: This pooled analysis demonstrated that young age, node-positive and G3 tumours, as well as TNBC, and non-pCR significantly increased the risk of LRR after NACT. Hence, there is a clear need to investigate better multimodality therapies in the post-neoadjuvant setting for high-risk patients.
AIM: This pooled analysis aimed to evaluate locoregional recurrence (LRR) rates of breast cancer (BC) after neoadjuvant chemotherapy (NACT) and to identify independent LRR predictors. METHODS: 10,075 women with primary BC from nine neoadjuvant trials were included. The primary outcome was the cumulative incidence rate of LRR as the first event after NACT. Distant recurrence, secondary malignancy or death were defined as competing events. For identifying LRR predictors, surgery type, pathological complete response (pCR), BC subtypes and other potential risk factors were evaluated. RESULTS: Median followup was 67 months (range 0-215), overall LRR rate was 9.5%, 4.1% in pCR versus 9.5% in non-pCR patients. Younger age, clinically positive lymph nodes, G3 tumours, non-pCR and TNBC but not surgery type were independent LRR predictors in multivariate analysis. Among BC subtypes, 5-year cumulative LRR rates were associated with higher risk in non-pCR versus pCR patients, which was significant for HR+/HER2- (5.9% vs 3.9%; HR = 2.32 [95%CI 1.22-4.43]; p = 0.011); HR-/HER2+ (14.8% vs 3.1%; HR = 4.26 [94%CI 2.35-7.71]; p < 0.001) and TNBC (18.5% vs 4.2%; HR = 4.10 [95%CI 2.88-5.82]; p < 0.001) but not for HR+/HER2+ (8.1% vs 4.8%; HR = 1.56 [95%CI 0.85-2.85]; p = 0.150). Within non-pCR subgroup, LRR risk was higher for HR-/HER2+ and TNBC vs HR+/HER2- (HR = 2.05 [95%CI 1.54-2.73]; p < 0.001 and HR = 2.77 [95%CI 2.27-3.39]; p < 0.001, respectively). CONCLUSIONS: This pooled analysis demonstrated that young age, node-positive and G3 tumours, as well as TNBC, and non-pCR significantly increased the risk of LRR after NACT. Hence, there is a clear need to investigate better multimodality therapies in the post-neoadjuvant setting for high-risk patients.
Authors: Christine V Pestana; Chad A Livasy; Erin E Donahue; Brittany Neelands; Antoinette R Tan; Terry Sarantou; Lejla Hadzikadic-Gusic; Richard L White Journal: Ann Surg Oncol Date: 2022-07-09 Impact factor: 4.339
Authors: M J M Magbanua; L B Swigart; H-T Wu; G L Hirst; C Yau; D M Wolf; A Tin; R Salari; S Shchegrova; H Pawar; A L Delson; A DeMichele; M C Liu; A J Chien; D Tripathy; S Asare; C-H J Lin; P Billings; A Aleshin; H Sethi; M Louie; B Zimmermann; L J Esserman; L J van 't Veer Journal: Ann Oncol Date: 2020-11-21 Impact factor: 51.769