Impact of age on pathological complete response and locoregional recurrence in locally advanced breast cancer after neoadjuvant chemotherapy

Abstract

Background Neoadjuvant chemotherapy (NAC) is the standard approach for downstaging of locally advanced breast cancer and can improve breast conservation rates. A pathological complete response (pCR) after NAC associated with favorable long-term outcomes has been described. There is still a high locoregional recurrence (LRR) rate after NAC and the influence of age on LRR after NAC is unclear. This study analyzed the relationship between age and LRR after NAC. Methods Two hundred and sixty-three patients with invasive breast cancer who received NAC followed by mastectomy or breast conserving surgery (BCS) were enrolled. Concurrent weekly epirubicin and docetaxel was the NAC regimen. Results Twenty-nine patients (11%) achieved a pCR after NAC. In univariate analysis, age <50 years, luminal B (HER2 positive) subtype, HER2 overexpression subtype, and triple-negative subtype were factors to predict a pCR. In multivariate analysis, age <50 years, luminal B (HER2 positive) type, HER2 overexpression, and triple-negative subtype were the independent factors to predict a pCR. No patients in the pCR group developed LRR compared with 31 patients in the non-pCR group. Eleven patients (6.9%) in the younger group (age <50 years) developed LRR compared with 20 patients (19.4%) in the older group (age ≥50 years). In multivariate analysis, younger age (<50 years) was the only independent prognostic factor for a LRR-free survival. Conclusion Younger age can predict a pCR and is an independent prognostic factor for LRR in locally advanced breast cancer patients after NAC as concurrent epirubicin and docetaxel.

The relationship between hormone receptor status, tumor size and clinical stage and the efficacy of neoadjuvant chemotherapy for locally advanced breast cancer, predictors of survival, and the establishment of Cox-Based risk prediction model and nomogram

“…In a well-known clinical trial, the National Surgically Assisted Breast and Bowel Project (NSABP) B-18, which compared the OS and DFS of patients in the preoperative and postoperative chemotherapy groups, showed no statistically significant difference in long-term follow-up. In present study among which NAC reached PCR and some studies indicated that pCR 12% reached after NAC, our result was consistently (11%) with that of Chou et al [18] and the RR (CR+PR) 64.6%. We found that pCR was more available in NAC in patients with HER-2 positive than in those with HER-2 negative, which was consistent with relevant literatures [19,20] .…”

“…The constructed nomogram successfully predicted the 3-year, 5-year, and 10-year OS of NAC patients, demonstrating good resolution and correction rate. Collecting relevant clinical data of the included patients through statistical analysis and up to 10 years of survival follow-up data, we found that the patient's ER, PR and HER-2 hormone receptor status, clinical stage and tumor size were significantly related to OS, this also confirmed by other researchers [18,22,23] . In the constructed nomogram, the C-index were 0.731 for the 3-year forecast, 0.743 for the 5-year forecast, and 0.726 for the 10-year forecast.…”

“…Jonathan et al's analysis of 103 neoadjuvant chemotherapy studies for locally advanced breast cancer found that the tumor size of patients before chemotherapy was related to LRR (p = 0.003) [30] , and our results are consistent with this. Chou et al confirmed that the younger patients (<50years) is the only independent factor favorable for LRR-freesurvival in patients with breast cancer after NAC with concurrent epirubicin and docetaxel [18] . However, other studies have concluded that age is not related to the prognosis of neoadjuvant chemotherapy [27] .…”

“…In our study, only HER-2 status was correlated with pCR (p = 0,025), and no correlation was found between patients' age and pCR. Chou et al reported that the age (<50 years) was an important factor (p=0.031) that affected whether the patient obtained pCR: the younger the age, the better the pCR could be achieved in the NAC process [18] . However, Lin et al retrospectively reported that age was not a factor that affected obtaining pCR, and breast cancer patients in different regions had different factors affecting geting pCR or having a good prognosis in NAC [24,25] .…”

Higher Locoregional Recurrence in Hormone Receptor-Negative Breast Cancer Patients with Residual Disease after Neoadjuvant Treatment Undergoing Breast Conservation Surgery

“…Our study con rmed that pCR after NAC provided better local control in all subtypes of breast cancer. The result was in line with the ndings of our previous report published in 2018, in which no LRR occurred in the pCR group and 31 patients (13.2%) in the non-pCR group with signi cant difference in total 263 patients all receiving neoadjuvant weekly epirubicin and docetaxel regimens [12]. One of the aims of this study was to enroll patients with all different subtypes of the same indication to avoid patient bias.…”