Predictors of Pathological Complete Response in Women with Clinical Complete Response to Neoadjuvant Chemotherapy in Breast Carcinoma

Abstract

Objective: There is insufficient information on predictors of pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) in breast carcinoma that also presented clinical complete response (cCR) evaluated in breast, axilla and breast and axilla. Methods: This retrospective study included 310 women with breast carcinoma who received NAC from 1/1/13 to 12/31/15 with follow-up until 8/31/16. The factors analyzed to predict pCR and cCR were menopausal status, Ki67, estrogen receptor, histologic grade, molecular subtype, tumor size, axilla status, and stage. Results: The cCR/pCR rates were 53.2/16.5% (breast), 76.3/36.8% (axilla) and 50.6/13.9% (breast and axilla). Molecular subtype and HER2-positive were independent predictors to confirm pCR in women with cCR, mainly triple negative (TN) in breast (OR 22.81, 95% CI 7.13–72.96) and breast and axilla (OR 36.06, 95% CI 8.77–148.26), but not in axilla. Ki67 ≥50% expression was predictor of cCR in breast (OR 2.00, 95% CI 1.31–3.06) and breast and axilla (OR 1.67, 95% CI 1.10–1.45). Conclusion: TN subtype and HER2-positive were the main independent predictors of pCR in women who also had cCR to NAC in breast and breast and axilla, but none was predictor in axilla. The Ki67 ≥50% was the independent predictor of cCR in breast and breast and axilla.

Predictive factors for omitting lymphadenectomy in patients with node‐positive breast cancer treated with neo‐adjuvant systemic therapy

“…In this cohort study of patients with cN+ breast cancer, 37.8% had no residual disease in the lymph nodes after NACT, thus corroborating previous results . Therefore, complete ALND after NACT could have been avoided in nearly 40% of patients with cN+ disease based on this approach.…”

“…We could find no reports indicating that a Ki‐67 level > 30% results in an almost two‐fold increased probability of ypN0, as we have shown . Recently, Resende et al found that a Ki‐67 ≥ 50% predicted clinical complete response in the breast (OR 2.00; 95% CI, 1.31‐3.06) and both the breast and axilla (OR 1.67; 95% CI, 1.10‐1.45). In patients with clinical stage II or III breast cancer, Wang et al also observed that pCR rates were significantly higher among patients with Ki‐67 levels > 40% compared with <40%, with pCR rates of 33.3% and 8.1%, respectively ( P < .001).…”

A Preoperative Nomogram for Predicting Chemoresistance to Neoadjuvant Chemotherapy in Patients with Locally Advanced Cervical Squamous Carcinoma Treated with Radical Hysterectomy

“…Premenopausal patients had lower levels of tumor biomarkers [19], consistent with the findings presented in our study. Lower tumor biomarker is correlated with lower pathological and clinical response to NACT in breast cancer [20], while lower SCC-Ag level was a risk factor of chemoresistance in our study, which suggests that menopausal status can be a significant predictor for chemoresistance. Moreover, a previous study has demonstrated that progenitor cells, which are fewer in postmenopausal patients, were resistant to adjuvant chemotherapy due to their active cell cycle, which may indicate that Zhengjie Ou, Nomogram for Chemoresistance in Cervical Cancer [21].…”

Axillary Pathologic Complete Response After Neoadjuvant Systemic Therapy by Breast Cancer Subtype in Patients With Initially Clinically Node-Positive Disease

“…After title and abstract screening of the remaining records, 159 studies were selected for full-text review. Eventually, 33 studies were included for qualitative and quantitative analysis after full-text assessment. The flow diagram of study selection is shown in Figure 1.…”

“…In 23 studies (9961 patients), all the patients had pathologically proven axillary lymph node metastases before NST. In the remaining 10 studies (47 570 patients), nodal positivity was solely based on results of the physical examination and imaging, or only part of the study population had pathologically proven axillary lymph node metastases before NST. The Table depicts the general characteristics of all included studies.…”