Long-term prognostic and predictive factors in 107 stage II/III breast cancer patients treated with anthracycline-based neoadjuvant chemotherapy

Abstract

Summary The heterogeneity of therapeutic modalities and eligibility criteria and the lack of long-term follow-up in most reports of neoadjuvant chemotherapy for breast cancer preclude us from drawing conclusions about its value in clinically relevant patient subgroups.The present study aims to identify predictive and prognostic factors in 107 non-inflammatory stage 11/Ill breast cancer patients treated between November 1980 and October 1991 with an anthracycline-based induction regimen before locoregional surgery. Preoperative chemotherapy comprised 3-6 cycles of doxorubicin (pirarubicin after 1986), vindesine, cyclophosphamide and 5-fluorouracil. Type of subsequent surgery and adjuvant treatment were decided individually. In analysis of outcome, univariate comparisons of end points were made using the log-rank test, and significant (P 5 0.05) pre-and post-therapeutic factors were incorporated in a Cox multivariate analysis. With a median follow-up of 81 months (range 32-164+ months), the median disease-free survival (DFS) is 90.5 months while median overall survival has not yet been reached. Cytoprognostic grade and histopathological response in both the primary and lymph nodes were independent covariates associated with locoregional relapse with or without DFS and overall survival. Eleven patients with pathological complete response remain free of disease with a 68-month median follow-up, while the 18 with residual microscopic disease on the specimen showed a 60% cumulative incidence of locoregional recurrence. Despite encouraging response rates based on clinical or radiological evaluation (87% or 70%), neither method showed any significant correlation with pathological response and failed to contribute prognostic information on patients' outcome. Pathological evaluation of antitumoral activity of primary chemotherapy remains a major source of prognostic information and might be used to select patients in need of additional adjuvant treatment.

A low number of tumor-infiltrating FOXP3-positive cells during primary systemic chemotherapy correlates with favorable anti-tumor response in patients with breast cancer

“…Although one possible prognostic factor is pCR after PSC (29), few prognostic factors are available for patients with operable breast cancer after PSC. We found here that fewer FOXP3-positive cells before and after PSC indicates a better prognosis and in the multivariate analysis, preserving relatively low number of FOXP3 during PSC (LL group) is significantly associated with a better RFS; therefore, the number of FOXP3-positive cells in the tumors during PSC could become another prognostic factor in the treatment for breast cancer patients with PSC.…”

Prognostic significance of a complete pathological response after induction chemotherapy in operable breast cancer

“…A pCR in the breast and axilla can be obtained in up to 33% of the cases, as a function of treatment used, in operable breast cancer (Hortobagyi et al, 1983;Lippman et al, 1986;Scholl et al, 1994;Schwartz et al, 1994;Powles et al, 1995;Brain et al, 1997;Bonadonna et al, 1998;Fisher et al, 1998;Morrell et al, 1998;Kuerer et al, 1999). It is known that neoadjuvant chemotherapy is able to convert clinically involved lymph nodes to a pathologically negative status in 25 -38% of breast tumours.…”

Breast pathology after cryotherapy. Histological regression of breast cancer after cryotherapy

“…There is no good correlation between the clinical and pathologically defined complete remission. In only 38% of all patients with clinical complete remission were no tumor remnants detected in pathological examinations as well [12][13][14]. Reduction of tumor mass is considered the most important change in chemosensitive tumors in the way that the number of invasive tumor cells decreases and the amount of tumor stroma increases after treatment.…”