Abstract
ABSTRACTObjectiveTo define a predictive factor for pathologic complete response, compare the oncologic outcomes associated with the degree of pathologic response after neoadjuvant chemotherapy, and to analyze pathologic complete response as a prognostic factor for overall survival and progression-free survival.MethodsA retrospective study of patients admitted to Hospital Estadual Mário Covas and Hospital Anchieta from 2008 to 2012, with locally advanced breast cancer. Hormone receptor status, HER2 status, histologic and nuclear grade, age upon diagnosis and histological type of the tumor were analyzed. Pathologic evaluation of the tumor was subdivided into pathologic complete response, defined by the absence of tumor; intermediate response, considered as a favorable stage; and poor response, considering low-responder patients. Data obtained were submitted to statistical analysis.ResultsThe study included 243 patients. There was an association of pathologic complete response with HER-2 negative, histological grade 3, stage III, hormone receptor negative, positive lymph node, older age and more advanced tumors. However, after multivariate analysis the only predictor of pathologic complete response was the presence of negative hormone receptor. By analyzing the prognostic factors, hormone receptor negative was considered as an independent risk factor, and pathologic complete response was considered as an independent protective factor.ConclusionHormone receptor negative is predictive of pathologic complete response and is an isolated risk factor for lower progression-free survival and overall survival. Pathologic complete response is a protective factor for these same survival analyses.
Highlights
Breast cancer has been the leading cause of death in Brazilian women since 1979
Probably because the disease is still diagnosed in advanced stages.[1]. Locally advanced breast cancer is classified according to the staging system proposed by the American Joint Committee on Cancer (AJCC) as IIB, IIIA, IIIB and IIIC, 25 to 30% of which are inoperable.[2]. One of the therapeutic modalities is neoadjuvant chemotherapy, which increases the likelihood of conservative surgery, allowing initial treatment of micro metastatic disease
Pathologic complete response is defined as the absence of residual invasive tumor in surgical tissue specimens from breast and axillary lymph nodes.[2,4] Tumor size, hormone receptor status, human epidermal growth factor receptor 2 (HER-2), molecular subtype and histological type are factors known to be associated with the pathologic response of the tumor.[5]
Summary
Probably because the disease is still diagnosed in advanced stages.[1] Locally advanced breast cancer is classified according to the staging system proposed by the American Joint Committee on Cancer (AJCC) as IIB, IIIA, IIIB and IIIC, 25 to 30% of which are inoperable.[2] One of the therapeutic modalities is neoadjuvant chemotherapy, which increases the likelihood of conservative surgery, allowing initial treatment of micro metastatic disease This approach allows assessing resistance to the chemotherapy regimen initially administered, offering an excellent opportunity to determine the best treatment regimen for the patient.[2,3] The MD Anderson Cancer Center has assessed more than 800 patients with disease in stages IIIA and IIIB over 25 years, and has attained objective response results in 60 to 80% of cases, complete clinical response in 15 to 20%, and pathologic complete response (pCR) in 5 to 10%, increasing the likelihood of conservative surgery.[4]. Its higher cell proliferation rate is related to worse prognosis when compared to luminal A.(7) Overexpression of HER2 occurs in 10 to 15% of breast cancers, is frequently hormonereceptor-negative, and has the second worst prognosis when compared to patients who do not show this gene amplification, molecularly targeted therapy improves the prognosis
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