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

Chollet, Philippe; Amat, S.; Curé, Hervé; Latour, M. De; Bouëdec, G. Le; Mouret-Reynier, M-A; Jp, Ferrière; Jl, Achard; Dauplat, J.; Penault‐Llorca, Frédérique

doi:10.1038/sj.bjc.6600210

Cited by 235 publications

(94 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Recently, this group has investigated pCR in both breast and axillary lymph nodes following neoadjuvant chemotherapy (Chollet et al, 2002). Retrospectively, they analysed 451 patients, of whom only 171 did not have clinically involved lymphadenopathy.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2006

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

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

et al. 2006

View full text Add to dashboard Cite

show abstract

“…Some studies showed the incidence and outcome of patients with a pathological complete response (pCR) after neoadjuvant chemotherapy (Machiavelli et al, 1998;Kuerer et al, 1999;Chollet et al, 2002). Conversely, what is the role of residual disease on survival in patients with operable breast cancer after neoadjuvant chemotherapy?…”

Section: Discussionmentioning

confidence: 99%

Is Nottingham prognostic index useful after induction chemotherapy in operable breast cancer?

et al. 2003

Self Cite

View full text Add to dashboard Cite

The Nottingham prognostic index (NPI), based on tumour size in breast, node involvement and Scarff -Bloom -Richardson (SBR) grading, has been shown to constitute a definitive prognostic factor of primary operable breast cancer in the adjuvant setting. We performed a retrospective study to evaluate the prognostic value of this index in 163 patients after neoadjuvant chemotherapy. Secondly, we examined the influence on survival of a revised NPI, only based on residual tumour size in breast and SBR grading in 228 patients, and consequently called breast grading index (BGI). The prognostic value of these two indices was also evaluated by replacing the SBR grade with the MSBR grade, a French modified SBR grading; the modified NPI (MNPI) and modified BGI (MBGI) were, respectively, obtained in 153 and 222 patients. At a median follow-up of 9.3 years, survival was significantly related to these four indices (Po0.001). Multivariate analysis revealed that MBGI was the only one which retained a prognostic influence on disease-free survival (Po0.02). In conclusion, the 'amount' of residual tumour in breast and/or nodes, as defined by NPI and revised indices, confers a determinant prognosis after neoadjuvant chemotherapy, inviting an alternative postsurgical treatment for a subgroup of patients with a decreased survival.

show abstract

“…For patients with neoadjuvant treatment, this approach enables the gathering of further information about the in vivo response to chemotherapy. Patients who have a complete nodal and breast pathological response enjoy a much better outcome than those who still have residual disease after therapy [46].…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided fine needle aspiration cytology in staging clinically node-negative invasive breast cancer

et al. 2011

View full text Add to dashboard Cite

The aim of this study was to evaluate the value of ultrasound (US)-guided axillary lymph node fine needle aspiration cytology (FNAC) in staging clinically nodenegative invasive breast cancer. Based on retrospective data, we analyzed sensitivity, specificity, and positive and negative predictive value and efficacy of preoperative axillary US-guided FNAC. A total of 108 consecutive female patients with histological-confirmed invasive breast cancer between January 2006 and December 2010 were included. The management decisions were based on cytological results. Twenty-two patients underwent neoadjuvant chemotherapy and 86 remaining patients benefited of primary surgery. Patients with positive cytology or included in neoadjuvant regimens were scheduled for axillary lymph node dissection (ALND), while patient with negative or nondiagnostic cytology underwent sentinel lymph node biopsy. Axillary US-guided FNAC was compared with definitive pathology of surgically removed lymph nodes. Axillary metastases were found in 55 out of 108 patients (50.9%). In these cases we proceeded with ALND. Excluding the group benefiting from neoadjuvant chemotherapy, we could spare a second surgical intervention for 37 out of 86 patients (43%). The axillary US with FNAC has a sensitivity of 73%, a specificity of 85%, a positive predictive value of 89%, and a negative predictive value of 66%. Without taking into account the neoadjuvant chemotherapy group, in which the statistical analyzes might be biased by the complete histological response, specificity and positive predictive value increased to 100% and negative predictive value to 71%. US combined with FNAC of axillary lymph nodes is a simple, minimally invasive, and reproducible diagnostic approach in improving the preoperative axillary staging of invasive breast cancer patients.Keywords Invasive breast cancer . Axillary node ultrasound . Axillary node cytology . Sentinel lymph node Background and objective

show abstract

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

Cited by 235 publications

References 22 publications

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

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

Is Nottingham prognostic index useful after induction chemotherapy in operable breast cancer?

Ultrasound-guided fine needle aspiration cytology in staging clinically node-negative invasive breast cancer

Contact Info

Product

Resources

About