Pathological response and survival after neoadjuvant therapy for breast cancer: a 30-year study

Breast. 2013 Jun;22(3):301-8. doi: 10.1016/j.breast.2012.07.012. Epub 2012 Aug 3.

Abstract

Purpose of the research: HER2-positive and triple-negative breast cancer (TNBC) still have a poor prognosis. Pathological complete response (pCR) is usually considered a surrogate marker for outcome. The aim of this study was to reconsider these parameters on a large population after a long follow-up. 348 patients with unilateral breast cancer who received neoadjuvant treatment at our institution over 30 years were included.

Results: Patients were classified according to hormonal receptors (HR) and HER2. Median follow-up was 7 years. pCR was significantly lower in HR+/HER2- tumors (P < 0.0001). The 7-year OS rates were 76.1% (HR+/HER2-), 60.1% (TNBC), 72.4% (HR+/HER2+), and 49.9% (HR-/HER2+). Disease-free survival (DFS) and OS differed significantly according to pCR. Among HER2+ patients, pCR rate, DFS and OS were greater with trastuzumab.

Conclusions: TNBC and HR-/HER2+ tumors have the worst outcome. pCR remains a significant prognostic factor. Trastuzumab strongly improves pCR and survival in HER2+ tumors.

MeSH terms

  • Antibodies, Monoclonal, Humanized / therapeutic use*
  • Antineoplastic Agents / therapeutic use*
  • Breast Neoplasms / chemistry*
  • Breast Neoplasms / pathology
  • Breast Neoplasms / therapy*
  • Carcinoma, Ductal, Breast / chemistry*
  • Carcinoma, Ductal, Breast / secondary
  • Carcinoma, Ductal, Breast / therapy*
  • Chemotherapy, Adjuvant
  • Disease-Free Survival
  • Female
  • Follow-Up Studies
  • Humans
  • Kaplan-Meier Estimate
  • Lymphatic Metastasis
  • Middle Aged
  • Neoadjuvant Therapy
  • Proportional Hazards Models
  • Radiotherapy, Adjuvant
  • Receptor, ErbB-2 / analysis
  • Receptors, Estrogen / analysis
  • Receptors, Progesterone / analysis
  • Trastuzumab

Substances

  • Antibodies, Monoclonal, Humanized
  • Antineoplastic Agents
  • Receptors, Estrogen
  • Receptors, Progesterone
  • Receptor, ErbB-2
  • Trastuzumab