Abstract
Neoadjuvant therapy is a common form of treatment in locally advanced breast cancer (LABC) patients. Besides some guidelines for grading regression, a standardized general scheme is not yet available. The aim of our study was to compare the prognostic impact of different regression grading systems, namely the TR/NR, Chevallier, Sataloff, Denkert-Sinn, Miller-Payne, NSABP-B18, Residual Disease in Breast and Nodes and Residual Cancer Burden (RCB) on disease-free (DFS) and overall survival (OS). Data of 746 breast cancer patients treated in neoadjuvant setting between 1999 and 2019 have been included. The different regression grades and follow-up data were collected from medical charts. Statistical analysis included the Kaplan-Meier method, log-rank test and multivariate Cox regression. The average patient age was 55 years. The DFS and OS estimates of patients with complete pathological regression and residual in situ carcinoma have been significantly more favorable than those having partial regression or no signs of regression (pDFS<0.001, pOS < 0.001). Significant differences were found between DFS estimates of classes with partial regression and without regression defined by RCB. Concerning DFS estimates, the RCB classification (p = 0.019), while regarding OS data the y-stage (p = 0.011) and the nodal status (ypN; p = 0.045) were significant prognosticators by multivariate Cox regression. Regression grading systems help the evaluation of regression in LABC patients treated with neoadjuvant therapy. Of the several grading systems compared, the RCB classification makes the best distinction between the outcomes of the different classes, therefore we recommend the inclusion of RCB into the histopathological findings.
Highlights
Treatment of locally advanced breast cancer (LABC) patients has been one of the great challenges of breast oncology for a long time
Imaging techniques serve as great options to monitor regression after Neoadjuvant therapy (NAT), histopathological review remains the gold standard in the evaluation procedure [25]
Several national guidelines aiming at the standardization of specimen cut up and reporting have been introduced, for example in Australia, Belgium, Germany, the UK, Netherlands, the USA and Hungary, there is no international agreement in the interpretation of tumor regression, in the definition of Pathological complete regression (pCR), and in the measurement of tumor size in cases where fibrosis develops as a result of NAT or multifocality is present [11, 26,27,28,29,30,31]
Summary
Treatment of locally advanced breast cancer (LABC) patients has been one of the great challenges of breast oncology for a long time. Neoadjuvant therapy (NAT) has changed the management of LABC, since it can achieve reduction or even complete regression of the primary tumor and its metastases [2, 3]. This downstaging can allow some patients who would have had mastectomy as surgical treatment to be treated with breast conservation [4]. Pathological complete regression occurs more frequently in triple negative or HER-2 positive cancers than in ER positive ones [8, 9]
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