Prognostic value of residual cancer burden and Miller-Payne system after neoadjuvant chemotherapy for breast cancer

Abstract

Background: To verify the feasibility of using the residual cancer burden (RCB) index to stratify prognosis of patients after neoadjuvant chemotherapy (NAC) and to compare RCB with the Miller-Payne system. Methods:We retrospectively analyzed clinicopathological data of patients receiving treatment between January 1, 2010 and December 31, 2018. Kaplan-Meier curves were used to compare the survival outcomes and estimate disease-free survival (DFS) and disease-specific survival (DSS). Harrell's concordance index (C-index) was used to evaluate the predictive accuracy of RCB and Miller-Payne system.Results: A total of 423 female patients with complete data were included in the analysis, with a median follow-up time of 58.5 months (range 7-126). 84 patients experienced recurrence, and 48 experienced breast cancer related death. RCB index and the Miller-Payne system were associated with prognosis in the whole cohort. Patients who achieved RCB-I had similar survival outcomes as those with pathological complete response (pCR, RCB-0). In whole cohort, for the RCB index and the Miller-Payne system, respectively, C-indexes for DFS were 0.73 and 0.64, for DSS were 0.74 and 0.64. The average RCB score was different among three subtypes (F=9.335, P<0.001). Conclusions:The RCB index and the Miller-Payne system can stratify survival outcome of patients after NAC, and RCB had a superior prediction accuracy, especially for triple-negative breast cancer (TNBC).New cut-off value should be sought in order to improve prediction accuracy.

Circulating Small EVs miRNAs as Predictors of Pathological Response to Neo-Adjuvant Therapy in Breast Cancer Patients

“…While several evaluation methods have been established [ 37 ], herein, we used RCB index and the MP system to evaluate pathological response to NAT. Both systems have been shown to accurately stratify survival outcome of patients after NAT [ 9 ].…”

“…The pCR using RCB index is defined as RCB-0 [ 8 ]. Both methods have shown associations with overall and disease-free survival, highlighting them as reliable methods for evaluating the pathological tumor response to neoadjuvant therapy [ 9 ]. However, the histological assessment of NAT response can be achieved only at the time of surgery, after the patient has been exposed to several rounds of treatment.…”

“…Few studies have investigated the predictive power of miRNAs in pathological response following NAT in BC. Most of them were only focused on triple negative BC (TNBC) [ 26 , 27 , 28 ], and were evaluated in tissue samples [ 29 ], or enrolled a smaller patient cohort [ 9 , 30 ]. Considering that sEVs miRNAs detected in liquid biopsies represent more accessible and less invasive biomarker sources, our study aims to explore the predictive value of these miRNAs for the pathological response to NAT in BC.…”

The Role of miR-375-3p, miR-210-3p and Let-7e-5p in the Pathological Response of Breast Cancer Patients to Neoadjuvant Therapy

“…It has five grades as follows: 1 (no change), 2 (minor reduction in tumour cells, but 30%), 3 (reduction in tumour cells by 30–90%), 4 (reduction in tumour cells with >90%) and 5 (no detectable tumour cells). Grades 1–4 correspond to partial pathological response (pPR) while grade 5 means pathological complete response (pCR) [ 7 , 8 ]. The RCB system measures the primary tumour’s bidimensional size and cellularity and assesses lymph nodes’ involvement.…”

“…The RCB system measures the primary tumour’s bidimensional size and cellularity and assesses lymph nodes’ involvement. The RCB index is classified as 0 (pCR), 1 (minimal residual disease), 2 (moderate residual disease) and 3 (extensive residual disease) [ 8 , 9 ]. The goal of NAT is pCR, as it plays an important prognostic role in BC patients.…”