Pathologic Complete Response and Its Impact on Breast Cancer Recurrence and Patient's Survival after Neoadjuvant Therapy: A Comprehensive Meta-Analysis.

Hui Liu,Liqiong Lv,Ming Cheng,Hui Gao,Tao Huang

doi:10.1155/2021/7545091

Hui Liu, Liqiong Lv + Show 3 more

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https://doi.org/10.1155/2021/7545091

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Abstract

Objective Earlier research has illustrated prognostic significance of pathologic complete response (pCR) in neoadjuvant therapy (NAT) for breast cancer, whereas correlation between treatment after achieving pCR and survival improvement remains underexplored. We attempted to measure the relation between pCR achieved after NAT and breast cancer recurrence or patient's survival. Methods We searched PubMed, EMBASE, Web of Science, and The Cochrane Library databases to find relevant articles from their inception to November 2020. According to eligibility criteria, studies were selected and basic data were extracted. The primary endpoint was the correlation between pCR achieved after NAT and event-free survival (EFS) or overall survival (OS). The results were obtained by directly extracting specific information from the literature or estimating individual data by survival curves on DigitizeIt software, presented with HR and 95% CI. All data were processed on Stata 14.0 software. Results Among 4338 articles, there were 25 eligible articles involving 8767 patients. The EFS of patients achieved pCR after NAT improved obviously (HR = 0.27; 95% CI, 0.24-0.31), especially in triple negative (HR = 0.17; 95% CI, 0.12-0.24) and HER2 positive (HR = 0.24; 95% CI, 0.20-0.30) breast cancer patients. As such, pCR after NAT was implicated in significantly increased OS (HR = 0.32; 95% CI, 0.27–0.37). Conclusion Achieving pCR after NAT was notably related to the improvement of EFS and OS, especially for patients with triple-negative and HER2-positive breast cancer. pCR can be a surrogate indicator for outcome of breast cancer patients after NAT, as well as a predictor of treatment efficacy after NAT. Besides, well-designed studies are still warranted for confirmation.

Highlights

Breast cancer is the most prevalent malignancy among women globally [1], and in China, morbidity and mortality are increasing [2]
Similar to the event-free survival (EFS) results, pathologic complete response (pCR) after neoadjuvant therapy (NAT) was correlated with increased overall survival (OS) (HR = 0:32; 95% CI, 0.27–0.37) (Figure 3)
A retrospective study assessed efficacy and safety of nanoparticle albumin-bound paclitaxel-based chemotherapy and docetaxel-based chemotherapy (DBC) as NAT for breast cancer, revealing that nPBC is correlated with favorable pCR [39]

Summary

Introduction

Breast cancer is the most prevalent malignancy among women globally [1], and in China, morbidity and mortality are increasing [2]. About 10%-20% patients present with locally advanced breast cancer (LABC) at diagnosis. Neoadjuvant therapy (NAT) is the standard nursing plan for patients in the early stage or those with LABC [3]. Early-stage or operable breast cancer is regarded to be curable in higher probability [4]. Primary objective of NAT is to treat distant metastases as early as possible and shrinkage the size of inoperable tumors, realizing conservative breast surgery [5]. Compared with postoperative or adjuvant chemotherapy, NAT can achieve a similar overall survival (OS) rate and higher breast preservation rate [7]. Questions have been raised about the correlation between further treatment and patient’s survival after patients achieved pathologic complete response (pCR) by NAT

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Conclusion