Tumor Biology and Response to Chemotherapy Impact Breast Cancer-specific Survival in Node-positive Breast Cancer Patients Treated With Neoadjuvant Chemotherapy

Abstract

Background Women with node-positive breast cancer have high risk for recurrence. We evaluate the impact of approximated tumor subtype and response to chemotherapy on long-term outcomes in a node-positive cohort receiving neoadjuvant chemotherapy. Methods ACOSOG Z1071 enrolled cT0-4N1-2 breast cancer patients treated with neoadjuvant chemotherapy from 2009-2011. Factors impacting breast cancer-specific survival (BCSS) and overall survival (OS) were analyzed. Results Median follow-up of 701 eligible patients was 4.1 years (0.4–6.5). Ninety patients (12.8%) died from breast cancer. Approximated subtype and chemotherapy response were significantly associated with BCSS and OS (p<0.0001). BCSS and OS was highest in patients who achieved pathologic complete response (pCR) (p<0.0001 and p<0.0001, respectively). 5-year BCSS was highest in HER2-positive disease (95.8%; 95%CI: 87.7–98.6), followed by hormone receptor (HR)-positive/HER2-negative (80.4%; 95%CI: 73.2–85.9) and lowest in triple-negative (TNBC) (74.8%; 95%CI: 66.6–81.2; p<0.0001). Similar patterns were seen in OS. In TNBC (n=174), 5-year BCSS was higher in patients with pCR versus residual disease (89.8%; 95%CI: 78.8–95.3 versus 65.8%; 95% CI: 54.5–74.9; p=0.0013). In HR-positive/HER2-negative (n=318) disease, BCSS was 100% in patients with pCR and 78.3% (95% CI: 70.4–84.3) in those with residual disease (p=0.018). In HER2-positive disease (n=204) there was no difference between pCR and residual disease (96.0%; 95%CI: 83.6–99.1 versus 95.8%; 95%CI: 81.4–99.1; p=0.77). Conclusion In node-positive breast cancer patients treated with neoadjuvant chemotherapy, BCSS and OS were associated with approximated subtype and chemotherapy response and were lowest in TNBC patients with residual disease. 5-year BCSS was >95% in HER2-positive disease independent of chemotherapy response.

Prognostic Genes of Breast Cancer Identified by Gene Co-expression Network Analysis

“…Based on the histopathological features of breast cancer, such as tumor size, lymph node status and grade, patients could be strati ed into high-and low-risk groups of recurrence and mortality (8). However, even in patients with histologically similar tumors, clinical outcomes of breast cancer patients are largely different due to the heterogeneity of breast cancer(9).…”

A prognostic 10‐lncRNA expression signature for predicting the risk of tumour recurrence in breast cancer patients

“…In order to predict recurrence and mortality of breast cancer, previous studies stratified patients into high‐ and low‐risk groups based on their histopathological features, including tumour size, lymph node status and grade . While because of molecular differences, clinical outcomes are largely different even in patients with histologically similar tumours .…”

“…4 In order to predict recurrence and mortality of breast cancer, previous studies stratified patients into high-and low-risk groups based on their histopathological features, including tumour size, lymph node status and grade. 5 While because of molecular differences, clinical outcomes are largely different even in patients with histologically similar tumours. 6 During the past decade, molecular studies demonstrated that there were at least four molecular subtypes of breast cancer: luminal, basal, human epidermal growth factor receptor 2 (HER2)-enriched and normallike.…”

A prognostic eight‐lncRNA expression signature in predicting recurrence of ER‐positive breast cancer receiving endocrine therapy

“…In previous studies, breast cancer patients have been separated into low‐ or high‐risk groups on the basis of several histopathological factors, including tumor size, tumor grade, and status of the lymph node to predict prognosis of breast cancer (Boughey et al, ). While in patients with histologically similar tumors, their clinical outcomes may be different due to molecular differences.…”