249P - Assessment of CPS+EG, neo-bioscore and modified neo-bioscore in breast cancer patients treated with preoperative systemic therapy: A multicenter cohort study

Abstract

BackgroundAn accurate prognostic assessment of breast cancer patients after preoperative systemic therapy (PST) is critical for physicians to adjust the systemic treatments. While both CPS+EG and Neo-Bioscore provide a satisfactory prediction, they, however, have limitations due to the lack of targeted therapies in current clinical practice. MethodsA retrospective multicenter cohort study was conducted from 12 participating hosipitals’ databases from 2006 to 2015. Five-year disease-free survival (DFS), disease-specific survival (DSS) and overall survival (OS) were calculated using the Kaplan-Meier Method. Area under the curve (AUC) of the three staging systems was compared. The detailed staging systems are summarized in Table. Wald test and maximum likelihood estimates in Cox proportional hazards model was used for multivariate analysis.Table249P Point assignment for the CPS+EG, neo-bioscore, and modified neo-bioscore staging systemsTableCancer StageCPS+ EG ScoreNeo-Bioscore (7 points)Modified Neo-Bioscore (8 points)Pretreatment Clinical Stage (CS)I000IIA000IIB111IIIA111IIIB222IIIC222Post-treatment Pathologic Stage (PS)0000I000IIA111IIB111IIIA111IIIB111IIIC222Tumor MarkerER negative111Grade 3111HER2-negative11HER2-positive & no Trastuzumab2Abbreviations: CPS+EG, clinical-pathologic staging system incorporating estrogen receptor–negative disease and nuclear grade 3 tumor pathology; ER, estrogen receptor; PR, progesterone receptor; HER2, human epidermal growth factor receptor 2. ResultsA total of 1077 patients were enrolled. The CPS+EG, Neo-Bioscore, and modified Neo-Bioscore could all stratify the DFS, DSS and OS (all P<0.001). While in the same stratum of Neo-Bioscore score 2 and 3, the HER2-positive patients without trastuzumab therapy had much poorer DSS (P=0.013 and P values <0.01, respectively) as compared to HER2-positive patients with trastuzumab therapy and HER2-negative patients. Only the modified Neo-Bioscore had a significantly higher stratification of 5-year DSS than PS (AUC 0.79 vs. 0.65, P=0.03). ConclusionsThe modified Neo-Bioscore could circumvent the limitation of CPS+EG or Neo-Bioscore. The access of appropriate treatment should be incorporated into the existing staging systems for more refined prognosis prediction. Clinical trial identificationThe trial protocol number: NCT03437837 Release date: February 19, 2018. Legal entity responsible for the studyXuening Duan AND Yimin Cui. FundingNational Key Research and Development Program of China. DisclosureAll authors have declared no conflicts of interest.