Considering all the limitations, from the present meta-analysis carried out on 22598 patients it appears unlikely that mastectomy provides better OS compared to BCS + WBRT in early breast cancer patients aged 40 years or younger.

Patients undergoing BCT after neoadjuvant chemotherapy have excellent rates of 5-year LRR-free survival that are affected by molecular subtype and by response to neoadjuvant chemotherapy.

Background Biologic factors guide treatment decisions and have a significant impact on prognosis for breast cancer patients. This study was undertaken to develop a staging system incorporating biologic factors in addition to standard anatomic factors in the American Joint Committee on Cancer (AJCC) pathologic stage (PS) to assess disease-specific survival (DSS). Methods 3,327 patients treated with surgery as an initial intervention at MD Anderson from 2007-2013 were identified. Multivariate analyses of factors including PS, T stage (T), nodal stage (N), grade (G), estrogen receptor (ER) status (E) and HER2 status (H) were performed to identify associations with DSS. A score of 0 to 4 was assigned for each factor by considering the hazard ratio magnitude. Multiple staging system models were then constructed: PS, PS+G, PS+G+E, PS+G+E+H, T+N, T+N+G, T+N+G+E, and T+N+G+E+H. Model performance was quantified using Harrell’s concordance index and Akaike Information Criterion (AIC) were used to compare model fits. Comparable cases from California (n=67,944) were used for validation. Results Median follow-up was 5.0 years (range, 0.1–8.8). Five-year DSS was 97.9% (95%CI:97.3%-98.4%). Models incorporating grade, ER status and HER2 status were most precise with identical C-index (0.81) and comparable AIC (994.9 for PS+G+E+H and 987.8 for T+N+G+E+H). Both models were externally validated. Conclusion These results confirm the importance of biologic factors in determining prognosis for breast cancer patients. We propose the Bioscore which incorporates grade, ER and HER2 status with AJCC PS to provide more refined stratification of breast cancer patients undergoing surgery as an initial intervention with respect to DSS.

Nomograms incorporating routine clinicopathologic parameters can predict axillary pCR in node-positive patients receiving NAC and may help to inform treatment decisions.