Predictors of Locoregional Recurrence After Failure to Achieve Pathologic Complete Response to Neoadjuvant Chemotherapy in Triple-Negative Breast Cancer

Abstract

Background: This study evaluated factors predictive of locoregional recurrence (LRR) in women with triple-negative breast cancer (TNBC) treated with neoadjuvant chemotherapy who do not experience pathologic complete response (pCR). Methods: This is a single-institution retrospective review of women with TNBC treated with neoadjuvant chemotherapy, surgery, and radiation therapy in 2000 through 2013. LRR was estimated between patients with and without pCR using the Kaplan-Meier method. Patient-, tumor-, and treatment-specific factors in patients without pCR were analyzed using the Cox proportional hazards method to evaluate factors predictive of LRR. Log-rank statistics were then used to compare LRR among these risk factors. Results: A total of 153 patients with a median follow-up of 48.6 months were included. The 4-year overall survival and LRR were 70% and 15%, respectively, and the 4-year LRR in patients with pCR was 0% versus 22.0% in those without (P<.001). In patients without pCR, lymphovascular space invasion (LVSI; hazard ratio, 3.92; 95% CI, 1.64–9.38; P=.002) and extranodal extension (ENE; hazard ratio, 3.32; 95% CI, 1.35–8.15; P=.009) were significant predictors of LRR in multivariable analysis. In these patients, the 4-year LRR with LVSI was 39.8% versus 15.0% without (P<.001). Similarly, the 4-year LRR was 48.1% with ENE versus 16.1% without (P=.002). In patients without pCR, the presence of both LVSI and ENE were associated with an even further increased risk of LRR compared with patients with either LVSI or ENE alone and those with neither LVSI nor ENE in the residual tumor (P<.001). Conclusions: In patients without pCR, the presence of LVSI and ENE increases the risk of LRR in TNBC. The risk of LRR is compounded when both LVSI and ENE are present in the same patient. Future clinical trials are warranted to lower the risk of LRR in these high-risk patients.

Radiological Assessment of Response to Neoadjuvant Chemotherapy in Breast Cancer Females, Using Standard and Spectral Mammography

“…Apart from the predictive and prognostic factors known to date, including staging, grading, HER2 status, hormone receptors status, and Ki 67%, the therapeutic response of the tumour to NACT provides information about the patient's prognosis. Obtaining complete pathological response (pCR) de ned as ypT0/Tis, ypN0 translates into better EFS and OS [22,23,24,25,26]. This served as the basis for the US Food and Drug Administration in July 2020 to accept pCR as the nal point of clinical studies in the neoadjuvant therapy of early breast cancer with a high recurrence risk [23].…”

Ki67 Index Changes and Tumor-Infiltrating Lymphocyte Levels Impact the Prognosis of Triple-Negative Breast Cancer Patients With Residual Disease After Neoadjuvant Chemotherapy

“…Finally, 109 patients were included in this study (Figure 1). All 109 included patients underwent NAC every 21 days [mean number of cycles: 4 (range, [3][4][5][6][7][8]]. The majority (90.8%) received an anthracycline plus taxane regimen.…”

“…A major advantage of this strategy is the ability to observe the tumor response to chemotherapy regimens before surgery ( 2 ). Patients with TNBC who achieve pathological complete response (pCR) after NAC have better prognosis than those who do not reach pCR ( 3 , 4 ); however, numerous patients with TNBC have residual disease (RD) after NAC, which is associated with a higher risk of relapse and distant metastasis ( 5 , 6 ). Novel prognostic biomarkers that can stratify these patients will be valuable for making individualized treatment decisions and maximizing therapeutic efficacy in specific patient groups.…”

Predictive and Prognostic Roles of Pathological Indicators for Patients with Breast Cancer on Neoadjuvant Chemotherapy

“…Liu et al [110] reported an association between post-NACT LVI and poor PFS (progression-free survival) as well as OS ( p < 0.91, respectively). Evidently, TNBC patients with LVI harbored residual cancer after NACT and were at significantly higher risk of LRR ( p < 0.001) [111]. The LVI situation is associated with many other clinical and pathological characteristics, including HR status, number of involved lymph nodes, and residual disease burden [112113].…”