Pathologic response after neoadjuvant chemotherapy predicts locoregional control in patients with triple negative breast cancer

Abstract

PurposeOur goal was to determine the impact of pathologic response after neoadjuvant chemotherapy in triple negative breast cancer (TNBC) on the subsequent risk of locoregional recurrence (LRR) and disease-free survival (DFS) in the setting of adjuvant radiation therapy.Methods and materialsThis was an institutional review board–approved retrospective chart review of patients with clinical stage I-III breast cancer treated with neoadjuvant chemotherapy, local surgery (breast conservation or mastectomy), and adjuvant radiation therapy between 1997 and 2015. Medical records were reviewed for clinical stage, tumor grade and subtype, neoadjuvant chemotherapy regimen, type of surgery, pathologic stage, use of radiation therapy, date and location of recurrence, and date of death. Molecular subtypes were defined using immunohistochemistry and histologic grade. ypT0 and ypN0 were defined as no residual invasive disease in breast or nodes, respectively. LRR was defined as any failure within the breast, chest wall, or regional lymph nodes. Statistical analysis was performed; LRR and DFS rates over 30 months were determined from Kaplan-Meier plots.ResultsNinety-four patients with TNBC were analyzed, of whom 72 received radiation therapy. This subgroup was isolated for further investigation. Median follow-up was 32.5 months in this group. The pathologic complete response (pCR) rate was 36%, and presence or absence of disease in breast and/or nodes was significantly predictive of LRR. In TNBC patients who received radiation therapy, 30-month LRR was 22% in 41 patients with ypT+ versus 0% in 31 patients with ypT0 (P = .003), 23% in 31 patients with ypN+ versus 5% in 41 patients with ypN0 (P = .016), and 20% in 46 patients with residual disease in breast or nodes versus 0% in 26 patients with pCR (P = .015). The difference in the rate of LRR between those who underwent lumpectomy versus mastectomy did not reach significance (8% vs 17%, respectively). Furthermore, patients with residual disease had a higher rate of DFS events (hazard ratio, 3.58; 95% confidence interval, 1.37-9.41; P = .006). The difference in DFS was not significantly associated with the type of surgery received.ConclusionsPatients with TNBC treated with neoadjuvant chemotherapy who have residual disease in the breast or lymph nodes at the time of surgery have significantly higher rates of locoregional failure and lower DFS compared with those with a pCR despite the use of adjuvant radiation therapy. Strategies to intensify therapy for patients with residual disease warrant further investigation.

Predictors of Locoregional Recurrence After Failure to Achieve Pathologic Complete Response to Neoadjuvant Chemotherapy in Triple-Negative Breast Cancer

“…However, this analysis encompassed all subtypes of breast cancers. In a TNBCspecific cohort of patients receiving NAC, surgery, and RT, Chen et al 12 reported that at 2-year follow-up, patients who experienced pCR had a 0% rate of LRR versus 27.5% in those who did not. This is similar to our findings, wherein patients who experienced pCR had a 0% rate of LRR versus 22% in those who did not.…”

Lymph node ratio as best prognostic factor in triple‐negative breast cancer patients with residual disease after neoadjuvant chemotherapy

“…[3][4][5][6] Moreover, patients that receive neo-adjuvant chemotherapy (NAC) have a low rate of complete pathological response (pCR), which ranges from 26.4% to 47.4%. [7][8][9][10] The standard criterion to assess response to NAC response is currently pCR. [11][12][13] New parameters as predictors of the prognosis of patients with breast cancer treated with NAC.…”

Expression of AQP3 and AQP5 as a prognostic marker in triple‑negative breast cancer

“…Breast cancer is the most common malignancy affecting women's health, with increasing incidence worldwide. About 1 in 8 women will be diagnosed with breast cancer in their lifetimes; moreover, 1 in 5 cases of breast cancer is the triple-negative subtype, that is, negative for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2) (1). Triple-negative breast cancer (TNBC) tends to be particularly aggressive, with a higher propensity for metastasis and locoregional recurrence compared with other subtypes (2).…”