A new histological grading system to assess response of breast cancers to primary chemotherapy: prognostic significance and survival

Ogston, Keith N.; Miller, Iain D.; Payne, Simon; Hutcheon, A. W.; Sarkar, T. K.; Smith, Ian; Schofield, Andrew Craig; Heys, Steven Darryll

doi:10.1016/s0960-9776(03)00106-1

Cited by 807 publications

(611 citation statements)

References 16 publications

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“…In addition to pathologic complete response, we also analyzed tumor volume reduction in all tumors, where we utilized a very standard and practical approach in estimating tumor volume reduction. We believe the method reported in this study is at least as objective, if not more, compared with other methods, [26][27][28] and yet quite simple compared with MD Anderson method 29 of estimating tumor volume reduction. This method made it possible to compare the differences between different tumor categories with confidence.…”

Section: Discussionmentioning

confidence: 70%

Semiquantitative hormone receptor level influences response to trastuzumab-containing neoadjuvant chemotherapy in HER2-positive breast cancer

et al. 2011

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Pathologic complete response to neoadjuvant chemotherapy without trastuzumab in hormone receptornegative/HER2 þ tumors is seen in 27-45% of cases. In contrast, estrogen receptor (ER) þ /HER2 þ tumors demonstrate pathologic complete response in B8% of cases and is generally limited to weak-to-moderate ER þ /HER2 þ tumors. It is speculated that addition of trastuzumab to neoadjuvant chemotherapy regimen will increase the pathologic complete response rates in all HER2 þ tumors. A list of HER2 þ patients who received neoadjuvant chemotherapy (with trastuzumab) in the years 2007-2010 was obtained from our hospital database. The 104 HER2 þ tumors were classified into three groups based on semiquantitative hormone receptor and HER2 results as follows: ERBB2 (ER-/PR-[H-score r10]/HER2 þ ), Luminal B-HER2 Hybrid (LBHH; weak to moderate ER þ [H-score 11-199]/HER2 þ ), and Luminal A-HER2 Hybrid (LAHH; strong ER þ [H-score Z200]/ HER2 þ ). Pathologic complete response was defined as absence of invasive carcinoma in the resection specimen and in the lymph nodes. Percentage tumor volume reduction was also calculated based on pretherapy size and detailed evaluation of the resection specimen. In all, 52% (25 of 48 cases) of ERBB2 tumors showed pathologic complete response, which was significantly higher than the pathologic complete response rate in LBHH (33%; 10 of 30) and LAHH (8%; 2 of 26) tumors. Average percentage tumor volume reduction was also highest in ERBB2 tumors (86%), followed by LBHH (74%) and LAHH (64%) tumors. We conclude that addition of trastuzumab to neoadjuvant chemotherapy regimen significantly increases the pathologic complete response rates in all HER2 þ tumors. However, the benefit of trastuzumab is highest in ER-negative tumors and progressively decreases with increase in tumor ER expression. This information can be utilized to counsel patients considered for neoadjuvant chemotherapy and the same principle could be applied in the adjuvant setting.

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Section: Discussionmentioning

confidence: 70%

Semiquantitative hormone receptor level influences response to trastuzumab-containing neoadjuvant chemotherapy in HER2-positive breast cancer

et al. 2011

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“…Recently, Miller and Payne have developed a novel 5 grade system based on the degree of tumour cell loss secondary to neoadjuvant chemotherapy (Ogston et al, 2003). Grade 5 in this classification is defined by the presence of no malignant cells, only vascular fibroelastic stroma, but the presence of DCIS is permitted.…”

Section: Discussionmentioning

confidence: 99%

“…a pathological complete response (pCR)) have a significantly improved survival (Bonadonna et al, 1998;Fisher et al, 1998;Kuerer et al, 1999), and pCR is often used as an early surrogate marker of treatment efficacy. However, there is no standard method for grading pathological response of breast tumours to neoadjuvant chemotherapy and a number of different classification systems have been proposed (Chevallier et al, 1993;Sataloff et al, 1995;Fisher et al, 1997;Honkoop et al, 1998;Kuerer et al, 1998;Ogston et al, 2003). Most, but not all, of these grading schemes have included both no residual disease of any sort and residual ductal carcinoma in situ (DCIS) without invasive disease in the definition of pCR.…”

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confidence: 99%

Pathological complete response and residual DCIS following neoadjuvant chemotherapy for breast carcinoma

et al. 2006

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Patients who have no residual invasive cancer following neoadjuvant chemotherapy for breast carcinoma have a better overall survival than those with residual disease. Many classification systems assessing pathological response to neoadjuvant chemotherapy include residual ductal carcinoma in situ (DCIS) only in the definition of pathological complete response. The purpose of this study was to investigate whether patients with residual DCIS only have the same prognosis as those with no residual invasive or in situ disease. A retrospective analysis of a prospectively maintained database identified 435 patients, who received neoadjuvant chemotherapy for operable breast cancer between February 1985 and February 2003. Of these, 30 (7%; 95% CI 5 -9%) had no residual invasive disease or DCIS and 20 (5%; CI 3 -7%) had residual DCIS only. With a median follow-up of 61 months, there was no statistical difference in disease-free survival, 80% (95% CI 60 -90%) in those with no residual invasive or in situ disease and 61% (95% CI 35 -80%) in those with DCIS only (P ¼ 0.4). No significant difference in 5-year overall survival was observed, 93% (95% CI 75 -98%) in those with no residual invasive or in situ disease and 82% (95% CI 52 -94%) in those with DCIS only (P ¼ 0.3). Due to the small number of patients and limited number of events in each group, it is not possible to draw definitive conclusions from this study. Further analyses of other databases are required to confirm our finding of no difference in disease-free and overall survival between patients with residual DCIS and those with no invasive or in situ disease following neoadjuvant chemotherapy for breast cancer.

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“…In case of disagreement, the case was reviewed jointly and final agreement reached by consensus. It should be noted that the categories of MRD and pCR that were used as outcome measures in this project correspond exactly to Grades 4 and 5 of the "Miller and Payne" system [7].…”

Section: Histopathology Reviewmentioning

confidence: 99%

“…Ogston et al [7] showed that the Miller-Payne classification system that is based on residual tumour cellularity is an independent predictor of survival in multivariate analysis. Symmans et al [8] also reported that the Residual Cancer Burden (RCB) Index that takes into account residual tumour size and cellularity as well as the number and size of nodal metastases is also predictive of outcome, with minimal residual disease carrying the same excellent prognosis as pCR.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of unidimensional and volumetric ultrasound measurements in predicting good pathological response to neoadjuvant chemotherapy in breast cancer patients

Gounaris

Provenzano

Vallier

et al. 2011

Breast Cancer Res Treat

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A new histological grading system to assess response of breast cancers to primary chemotherapy: prognostic significance and survival

Cited by 807 publications

References 16 publications

Semiquantitative hormone receptor level influences response to trastuzumab-containing neoadjuvant chemotherapy in HER2-positive breast cancer

Semiquantitative hormone receptor level influences response to trastuzumab-containing neoadjuvant chemotherapy in HER2-positive breast cancer

Pathological complete response and residual DCIS following neoadjuvant chemotherapy for breast carcinoma

Accuracy of unidimensional and volumetric ultrasound measurements in predicting good pathological response to neoadjuvant chemotherapy in breast cancer patients

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