Prognostic role of ER+ associated with other clinical and biological features in patients with T4 breast cancer achieving less than a pathological complete response (<pCR) after primary chemotherapy: 10-year results.

Abstract

e11047 Background: The achievement of pCR correlates with significantly better outcomes irrespective of common clinical prognostic factors. By contrast less than pCR (<pCR) identifies a heterogeneous group of patients (pts) at different risk of recurrence and death, being ER+ the subgroup with the best prognosis. Aim of our study was to evaluate the influence of baseline PgR, HER2, grade, age, inflammatory disease (T4d), postsurgical residual pT and pLN and type of primary regimen, on long-term DFS in ER+ T4 pts achieving <pCR. Methods: We analyzed 80 ER+ of 132 consecutive T4 pts <pCR after anthra-based (FEC, 29 pts) or anthra-cisplatin-based (cisplatin, epirubicin, vinorelbine, 51 pts) primary chemotherapy. All patients received the same adjuvant chemo-endocrine therapy; trastuzumab was not allowed; 32 pts (40%) were <50y; 18 (22%) T4d; 27 (34%) G3; 10 (12,5%) HER2+; 40 (50%) PgR+; 50 (62,5%) pT0-2; 30 (37,5%) pT3-4; 50 (75%) pLN+. DFS was analyzed using Cox proportional hazards ratios (HR). Results: After a median follow-up of 120 months (14-205 ), as expected 10 y DFS was better in ER+ group (80 pts) than in ER- (52 pts) (41% vs 25%; p=0.049). Among ER+ patients, HER2+, pLN+, T4d, anthra-based versus cisplatin-based primary chemotherapy, were associated with significantly poor DFS (HRs > 2). None of the other factors affected significantly the prognosis. Conclusions: Overall, ER+ status is predictor for better DFS in patients <pCR. The association with HER2+, pLN+, inflammatory disease and anthra versus anthra-cisplatin based primary chemotherapy, decreases the likelihood of DFS. These patients should be considered for innovative treatment in addition to chemo-endocrine therapy. ER+ HR IC 95% p value ER+ HR IC 95% p value PgR+/PgR- 1.16 0.66-2.1 0.60 HER2+/HER2- 2.07 0.89-4.82 0.09 G2/G3 0.79 0.42-1.49 0.47 T4abc/T4d 0.51 0.27-0.96 0.037 <50/≥50 0.82 0.46-1.46 0.50 pLN+/pLN- 2.56 1.08-6.03 0.032 pT0-2/pT3-4 1.32 0.74-2.36 0.35 anthra/cisplatin 2.07 1.07-3.98 0.030 No significant financial relationships to disclose.