Clinical and pathologic outcome analysis with the preoperative systemic therapy in operable breast cancer.

Abstract

e11094 Background: Preoperative treatment is been increasingly used in early-stage breast cancer. The identification of intermediate markers that correlate with outcome (pathologic response and or survival) in carefully selected patient groups may have clinical utility. Methods: Retrospective, university-based single institution tumor registry data analysis. Results: 41 patients (54% Caucasian, 41% African American), median age of 52 years with stage I-III breast cancer underwent preoperative systemic therapy at our institution between 1998 and 2008. Pathology details were available in 35 patients. There were 88% ductal, 10% lobular, 34% hormone receptors positive, 28% HER2-neu positive and 43% triple negatives. IHC assessment of the nuclear antigen Ki-67 was performed in 13 patients on the diagnostic biopsy. Anthracycline and or taxane chemotherapy was given to 66% and 54% patients respectively for a median of 17 weeks. Three patients received preoperative trastuzumab. Mastectomy and BCS were performed in 44% and 41% respectively. Eight (23%) patients achieved pCR following preoperative therapy. In the group with pCR, 38% had high Ki-67 on the diagnostic biopsy. Among the rest of 27 patients with < pCR, 19% had local residual DCIS. Bad prognostic features including high Ki-67 (30%), nuclear grade 3 (33%) and angio-lymphatic invasion (37%) were seen in <pCR group. Postoperative radiation therapy and chemotherapy were documented in eight and 21 patients respectively. The median DFS and OS were 27 and 34 months for the entire group. There was no significant difference in median survival on subgroup analysis (32 months in pCR vs. 36 months in < pCR, p = 0.28). Among the group with < pCR, patients with bad prognostic features including triple negatives, HER2-neu positive, high residual Ki-67, nuclear grade 3 and or angio-lymphatic invasion had a similar median survival of 36 months. Conclusions: In this retrospective series, conventional prognostic markers did not appear to predict for response to or long term survival following neoadjuvant therapy. Newer markers, such as those identified by micro-array analysis, will be necessary to identify those patients who will benefit most from the neoadjuvant approach. No significant financial relationships to disclose.