Prognostic assessment of breast carcinoma submitted to neoadjuvant chemotherapy with pathological non-complete response

Abstract

Background Breast cancer with pathological non-complete response (non-pCR) after neoadjuvant chemotherapy (NAC) has a worse prognosis. Despite Neo-Bioscore has been validated as an independent prognostic model for breast cancer submitted to NAC, non-pCR carcinoma was not assessed in this setting. Methods This is a retrospective trial that included women with localized breast cancer who underwent NAC and had non-pCR carcinoma in surgical specimen between 01/01/2013 to 12/31/2015 with a three-year follow-up. Survival analysis was performed by Kaplan-Meier estimator and hazard ratio (HR) set by log-rank test for the primary and secondary endpoints, respectively Disease-Free Survival (DFS) and Overall Survival (OS). According to Neo-Bioscore, the proposed prognostic model named Clustered Neo-Bioscore was classified into low (0–3), low-intermediate (4–5), high-intermediate (6) and high (7) risk. The prognostic accuracy for recurrence risk was assessed by time-dependent receiver operating characteristic (time-ROC) methodology. Multivariate Cox regression assessed the menopausal status, histological grade, Ki-67, estrogen receptor, HER2, tumor subtype, pathological and clinical stages. Confidence interval at 95% (CI95%) and statistical significance at set 2-sided p -value less than 0.05 were adopted. Results Among the 310 women enrolled, 267 patients (86.2%) had non-pCR carcinoma presenting size T3/T4 (63.3%), node-positive axilla (74.9%), stage III (62.9%), Ki-67 ≥ 20% (71.9%) and non-luminal A (78.3%). Non-pCR carcinoma presented worse DFS-3y (HR = 3.88, CI95% = 1.18–11.95) but not OS-3y (HR = 2.73, CI95% = 0.66–11.40). Clustered Neo-Bioscore discerned the recurrence risk for non-pCR carcinoma: low (DFS-3y = 0.86; baseline), low-intermediate (DFS-3y = 0.70; HR = 2.61), high-intermediate (DFS-3y = 0.13, HR = 14.05), and high (DFS-3y = not achieved; HR = 22.19). The prognostic accuracy was similar between Clustered Neo-Bioscore and Neo-Bioscore (0.76 vs 0.78, p > 0.05). Triple-negative subtype (HR = 3.6, CI95% = 1.19–10.92) and pathological stages II (HR = 5.35, CI95% = 1.19–24.01) and III (HR = 6.56, CI95% = 1.29–33.32) were prognoses for low-intermediate risk, whereas pathological stage III (HR = 13.0, CI95% = 1.60–106.10) was prognosis for low risk. Conclusions Clustered Neo-Bioscore represents a novel prognostic model of non-pCR carcinoma undergoing NAC with a more simplified and appropriate score pattern in the assessment of prognostic factors. Electronic supplementary material The online version of this article (10.1186/s12885-019-5812-0) contains supplementary material, which is available to authorized users.

<p>A Study on Clinical and Pathological Responses to Neoadjuvant Chemotherapy in Breast Carcinoma</p>

“…In our study the post-menopausal group and those aged above 51 had a better clinical response ( P <0.05) than those who were pre-menopausal and those aged below 50 years. Resende et al 23 shows no relationship with menopausal state. Del Prete et al 21 showed good pathological response in premenopausal patients.…”

“…In Miglietta et al, 22 a good response was seen with Her2-neu over-expressed tumors. Resende et al 23 showed no relationship with HER2–neu status of the patients. In our study the post-menopausal group and those aged above 51 had a better clinical response ( P <0.05) than those who were pre-menopausal and those aged below 50 years.…”

“…In contrast, Awad et al showed better responses in rapidly proliferating tumors with a higher grade. 24 Resende et al 23 also showed good response in high grade tumors.…”

Circulating Low Density Neutrophils of Breast Cancer Patients are Associated with their Worse Prognosis due to the Impairment of T cell Responses

“…Then, we further investigated the impact of LDN in the response to standard treatment, especially in non-metastatic BC patients selected for neoadjuvant chemotherapy (NACT), since a poor response to this treatment is a predictive factor for recurrence and disease progression (18,19). NACT is the treatment of choice for BC patients with tumors larger than 2 cm and/or with disease extension to axillary lymph nodes, or with inflammatory and inoperable tumors, independently on the BC subtype.…”

Association between the methylation status of PCDH17 and the efficacy of neoadjuvant chemotherapy in triple-negative breast cancer

“…However, subgroup analysis revealed that the survival rates of patients who did not achieve pCR were lower compared with those of patients who achieved pCR, even when compared with the adjuvant chemotherapy group ( 7 – 9 ). This may be due to the increased risk of recurrence caused by residual lesions in patients who received NAC but did not achieve pCR ( 10 ). TNBC is a heterogeneous disease, which comprises subtypes with different biological behaviors and clinical outcomes ( 11 ).…”