Skip to main content

Advertisement

Log in

High prognostic significance of residual disease after neoadjuvant chemotherapy: a retrospective study in 710 patients with operable breast cancer

  • Clinical trial
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

An Erratum to this article was published on 22 June 2006

Summary

Prognostic factors are used to help clinical decision-making in selecting the appropriate treatment for individual patients. The purpose of this retrospective study was to identify one or more factors associated with overall survival (OS) and disease-free survival (DFS), in 710 patients with operable breast cancer, subjected to neoadjuvant chemotherapy followed by surgery, radiotherapy and adjuvant treatments. At a median follow-up of 7.6 years, univariate analysis showed that pathological complete response (pCR) was significantly related to survival (p < 0.003), as well as accepted prognostic factors, as SBR and MSBR grades, hormonal receptors or node involvement at surgery, who remained significant in our study (p < 0.001). The revised Nottingham prognostic index (NPI) and related indices (BGI, MNPI and MBGI) were also significantly associated to survival (p < 0.003). In multivariate analysis, node involvement and MSBR grade remained prognostic factors for OS and DFS (p < 0.0003 and p < 0.02, respectively). The MNPI and pCR were significantly related with OS (p = 0.04) and pts with hormonal receptor-positive tumours had a better DFS than others (p = 0.004). Among all clinical and pathological parameters, axillary dissection after neoadjuvant chemotherapy is still important to determine node involvement, a major prognostic factor. Moreover, MSBR grade seemed to be more accurate and predictive of long-term outcome than the standard SBR grade. It is concluded that, outside any other ‘biological’ factor, residual disease in breast and nodes must be strongly considered after an induction chemotherapy so as to choose adjuvant treatment for the individual patient.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Fisher B, Bryant J, Wolmark N, Mamounas E, Brown A, Fisher ER, Wickerham DL, Begovic M, DeCillis A, Robidoux A, Margolese RG, Cruz AB Jr, Hoehn JL, Lees AW, Dimitrov NV, Bear HD: Effect of preoperative chemotherapy on the outcome of women with operable breast cancer J Clin Oncol 16(8): 2672–2685, 1998

    PubMed  CAS  Google Scholar 

  • Scholl SM, Pierga JY, Asselain B, Beuzeboc P, Dorval T, Garcia-Giralt E, Jouve M, Palangie T, Remvikos Y, Durand JC: Breast tumour response to primary chemotherapy predicts local and distant control as well as survival Eur J Cancer 31A(12): 1969–1975, 1995

    Article  PubMed  CAS  Google Scholar 

  • Semiglazov VF, Topuzov EE, Bavli JL, Moiseyenko VM, Ivanova OA, Seleznev IK, Orlov AA, Barash NY, Golubeva OM, Chepic OF: Primary (neoadjuvant) chemotherapy and radiotherapy compared with primary radiotherapy alone in stage IIb–IIIa breast cancer. Ann Oncol 5(7): 591–595, 1994

    PubMed  CAS  Google Scholar 

  • Makris A, Powles TJ, Dowsett M, Osborne CK, Trott PA, Fernando IN, Ashley SE, Ormerod MG, Titley JC, Gregory RK, Allred DC: Prediction of response to neoadjuvant chemoendocrine therapy in primary breast carcinomas Clin Cancer Res 3(4): 593–600, 1997

    PubMed  CAS  Google Scholar 

  • Mauriac L, MacGrogan G, Avril A, Durand M, Floquet A, Debled M, Dilhuydy JM, Bonichon F: Neoadjuvant chemotherapy for operable breast carcinoma larger than 3 cm: a unicentre randomized trial with a 124-month median follow-up. Institut Bergonie Bordeaux Groupe Sein (IBBGS) Ann Oncol 10(1): 47–52, 1999

    Article  PubMed  CAS  Google Scholar 

  • van der Hage JA, van de Velde CJ, Julien JP, Tubiana-Hulin M, Vandervelden C, Duchateau L: Preoperative chemotherapy in primary operable breast cancer: results from the European Organization for Research and Treatment of Cancer trial 10902 J Clin Oncol 19(22): 4224–4237, 2001

    PubMed  Google Scholar 

  • Adjuvant Therapy for Breast Cancer. NIH Consensus Statement 17(4): 1–35, 2000

    Google Scholar 

  • Fisher B, Gunduz N, Saffer EA: Influence of the interval between primary tumor removal and chemotherapy on kinetics and growth of metastases Cancer Res 43(4): 1488–1492, 1983

    PubMed  CAS  Google Scholar 

  • Kuerer HM, Newman LA, Smith TL, Ames FC, Hunt KK, Dhingra K, Theriault RL, Singh G, Binkley SM, Sneige N, Buchholz TA, Ross MI, McNeese MD, Buzdar AU, Hortobagyi GN, Singletary SE: Clinical course of breast cancer patients with complete pathologic primary tumor and axillary lymph node response to doxorubicin-based neoadjuvant chemotherapy J Clin Oncol 17(2): 460–469, 1999

    PubMed  CAS  Google Scholar 

  • Pierga JY, Mouret E, Dieras V, Laurence V, Beuzeboc P, Dorval T, Palangie T, Jouve M, Vincent-Salomon A, Scholl S, Extra JM, Asselain B, Pouillart P: Prognostic value of persistent node involvement after neoadjuvant chemotherapy in patients with operable breast cancer Br J Cancer 83(11): 1480–1487, 2000

    Article  PubMed  CAS  Google Scholar 

  • Simpson JF, Page DL: Status of breast cancer prognostication based on histopathologic data Am J Clin Pathol 102: S3–8, 1994

    PubMed  CAS  Google Scholar 

  • Bloom HJ, Richardson WW: Histological grading and prognosis in breast cancer Br J Cancer 11: 359–377, 1957

    PubMed  CAS  Google Scholar 

  • Elston CW, Ellis IO: Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up Histopathology 19(5): 403–410, 1991

    Article  PubMed  CAS  Google Scholar 

  • Cure H, Amat S, Penault-Llorca F, Le Bouedec G, Ferriere JP, Mouret-Reynier MA, Kwiatkowski F, Feillel V, Dauplat J, Chollet P: Prognostic value of residual node involvement in operable breast cancer after induction chemotherapy Breast Cancer Res Treat 76(1): 37–45, 2002

    Article  PubMed  CAS  Google Scholar 

  • Chollet P, Amat S, Cure H, de Latour M, Le Bouedec G, Mouret-Reynier MA, Ferriere JP, Achard JL, Dauplat J, Penault-Llorca F: Prognostic significance of a complete pathological response after induction chemotherapy in operable breast cancer Br J Cancer 86(7): 1041–1046, 2002

    Article  PubMed  CAS  Google Scholar 

  • Chollet P, Amat S, Belembaogo E, Cure H, de Latour M, Dauplat J, Le Bouedec G, Mouret-Reynier MA, Ferriere JP, Penault-Llorca F: Is Nottingham prognostic index useful after induction chemotherapy in operable breast cancer? Br J Cancer 89(7): 1185–1191, 2003

    Article  PubMed  CAS  Google Scholar 

  • Amat S, Penault-Llorca F, Cure H, Le Bouedec G, Achard JL, Van Praagh I, Feillel V, Mouret-Reynier MA, Dauplat J, Chollet P: Scarff-Bloom-Richardson (SBR) grading: a pleiotropic marker of chemosensitivity in invasive ductal breast carcinomas treated by neoadjuvant chemotherapy Int J Oncol 20(4): 791–796, 2002

    PubMed  CAS  Google Scholar 

  • Sobin LH, Wittekind CH: UICC – TNM Classification of Malignant Tumours. 5th edition. New York: Wiley-Liss, 1997

    Google Scholar 

  • Chevallier B, Roche H, Olivier JP, Chollet P, Hurteloup P: Inflammatory breast cancer. Pilot study of intensive induction chemotherapy (FEC-HD) results in a high histologic response rate Am J Clin Oncol 16: 223–228, 1993

    Article  PubMed  CAS  Google Scholar 

  • Le Doussal V, Tubiana-Hulin M, Friedman S, Hacene K, Spyratos F, Brunet M: Prognostic value of histologic grade nuclear components of Scarff-Bloom-Richardson (SBR). An improved score modification based on a multivariate analysis of 1262 invasive ductal breast carcinomas Cancer 64(9): 1914–1921, 1989

    Article  PubMed  CAS  Google Scholar 

  • Kaplan EL, Meier P: Nonparametric estimation from incomplete observations. Clinical course of breast cancer J Am Stat Assoc 185: 1457–1481, 1958

    Google Scholar 

  • Mantel N: Evaluation of survival data and two row rank order statistics arising in its consideration Cancer chemother Rep 50(3): 163–170, 1966

    PubMed  CAS  Google Scholar 

  • Cox DR: Regression models and life tables JR Stat Soc B 34: 187–202, 1972

    Google Scholar 

  • Bonadonna G, Valagussa P, Brambilla C, Ferrari L, Moliterni A, Terenziani M, Zambetti M: Primary chemotherapy in operable breast cancer: eight-year experience at the Milan Cancer Institute J Clin Oncol 16(1): 93–100, 1998

    PubMed  CAS  Google Scholar 

  • Botti C, Vici P, Lopez M, Scinto AF, Cognetti F, Cavaliere R: Prognostic value of lymph node metastases after neoadjuvant chemotherapy for large-sized operable carcinoma of the breast J Am Coll Surg 181(3): 202–208, 1995

    PubMed  CAS  Google Scholar 

  • Noguchi M, Current controversies concerning sentinel lymph node biopsy for breast cancer Breast Cancer Res Treat 84(3): 261–271, 2004

    Article  PubMed  Google Scholar 

  • Pendas S, Jakub J, Giuliano R, Gardner M, Swor GB, Reintgen DS: The role of sentinel lymph node biopsy in patients with ductal carcinoma in situ or with locally advanced breast cancer receiving neoadjuvant chemotherapy Cancer Control 11(4): 231–235, 2004

    PubMed  Google Scholar 

  • Chang J, Powles TJ, Allred DC, Ashley SE, Clark GM, Makris A, Assersohn L, Gregory RK, Osborne CK, Dowsett M: Biologic markers as predictors of clinical outcome from systemic therapy for primary operable breast cancer J Clin Oncol 17(10): 3058–3063, 1999

    PubMed  CAS  Google Scholar 

  • Sjöström J, Krajewski S, Franssila K, Niskanen E, Wasenius VM, Nordling S, Reed JC, Blomqvist C: A multivariate analysis of tumour biological factors predicting response to cytotoxic treatment in advanced breast cancer Br J Cancer 78(6): 812–815, 1998

    PubMed  Google Scholar 

  • Hilsenbeck SG, Ravdin PM, de Moor CA, Chamness GC, Osborne CK, Clark GM: Time-dependence of hazard ratios for prognostic factors in primary breast cancer Breast Cancer Res Treat 52(1–3): 227–237, 1998

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sophie Catherine Abrial.

Additional information

Address for offprints and correspondence: Sophie Amat, Centre Jean Perrin, Bureau de Recherche Clinique, 58 rue Montalembert, BP 392, 63011 Clermont-Ferrand Cedex 1, France; Tel.: +33-4-73-27-80-05; Fax: +33-4-73-27-80-29; E-mail: sophie.amat@libertysurf.fr

An erratum to this article can be found at http://dx.doi.org/10.1007/s10549-006-9237-5

Rights and permissions

Reprints and permissions

About this article

Cite this article

Abrial, S.C., Penault-Llorca, F., Delva, R. et al. High prognostic significance of residual disease after neoadjuvant chemotherapy: a retrospective study in 710 patients with operable breast cancer. Breast Cancer Res Treat 94, 255–263 (2005). https://doi.org/10.1007/s10549-005-9008-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-005-9008-8

Keywords

Navigation