Prediction of local recurrence risk after neoadjuvant chemotherapy in patients with primary breast cancer: Clinical utility of the MD Anderson Prognostic Index.

Laura L Michel,André Hennigs,Christof Sohn,Justo Lorenzo Bermejo,Katharina Smetanay,Florian Schütz,Julia Seitz,Laura Sommer,Andreas Schneeweiss,Jörg Heil,Michael Golatta,Frederik Marmé,Alexandra Von Au,Rosa González Silos

doi:10.1371/journal.pone.0211337

Abstract

BackgroundLocoregional recurrence after neoadjuvant chemotherapy for primary breast cancer is associated with poor prognosis. It is essential to identify patients at high risk of locoregional recurrence who may benefit from extended local therapy. Here, we examined the prediction accuracy and clinical applicability of the MD Anderson Prognostic Index (MDAPI).MethodsProspective clinical data from 456 patients treated between 2003 and 2011 was analyzed. The Kaplan-Meier method was used to examine the probabilities of locoregional recurrence, local recurrence and distant metastases according to individual prognosis score, stratified by type of surgery (breast conserving therapy or mastectomy). The possible confounding of the relationship between recurrence risk and MDAPI by established risk factors was accounted for in multiple survival regression models. To define the clinical utility of the MDAPI we analyzed its performance to predict locoregional recurrence censoring patients with prior or simultaneous distant metastases.ResultsMastectomized patients (42% of the patients) presented with more advanced tumor stage, lower tumor grade, hormone-receptor positive disease and consequently lower pathological complete response rates. Only a few patients presented with high-risk scores (2,7% MDAPI≥3). All patients with high-risk MDAPI score (MDAPI ≥3) who developed locoregional recurrence were simultaneously affected by distant metastases.ConclusionOur data do not support a clinical utility of the MDAPI to guide local therapy.

Highlights

Locoregional recurrence (LRR) is associated with poor overall survival (OS).[1,2] It is essential to identify patients at high risk of LRR that might benefit from more radical local treatment but at the same time to avoid overtreatment.Neoadjuvant chemotherapy (NAC) is the treatment of choice for locally advanced primary breast cancer (PBC) but is frequently used for early disease.[3,4] NAC increases breast conservation rates and offers the unique opportunity to evaluate response to treatment in vivo.Chen et al developed the MD Anderson Prognostic index (MDAPI) to identify patients that may benefit from an extended local therapy based on four independent risk factors for LRR after NAC and breast conserving therapy (BCT).[5]
The Kaplan-Meier method was used to examine the probabilities of locoregional recurrence, local recurrence and distant metastases according to individual prognosis score, stratified by type of surgery
A few patients presented with high-risk scores (2,7% MD Anderson Prognostic Index (MDAPI) 3)

Summary

Introduction

Locoregional recurrence (LRR) is associated with poor overall survival (OS).[1,2] It is essential to identify patients at high risk of LRR that might benefit from more radical local treatment (e.g. mastectomy or extended radiation fields) but at the same time to avoid overtreatment. Chen et al developed the MD Anderson Prognostic index (MDAPI) to identify patients that may benefit from an extended local therapy based on four independent risk factors for LRR after NAC and breast conserving therapy (BCT).[5] The MDAPI is composed of clinical nodal status, residual pathologic tumor size, pattern of residual disease and lymphovascular space invasion in the surgical specimen. It is essential to identify patients at high risk of locoregional recurrence who may benefit from extended local therapy. We examined the prediction accuracy and clinical applicability of the MD Anderson Prognostic Index (MDAPI)

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