Prognostic Value of Axillary Nodal Ratio after Neoadjuvant Chemotherapy of Doxorubicin/Cyclophosphamide Followed by Docetaxel in Breast Cancer: A Multicenter Retrospective Cohort Study

Kim, Se Hyun; Jung, Kyung Hae; Kim, Tae Yong; Im, Seock Ah; Choi, In Sil; Chae, Yee Soo; Baek, Sun Kyung; Kang, Seok Yun; Park, Sarah; Park, In Hae; Lee, Keun Seok; Choi, Yoon Ji; Lee, Soo Hyun; Sohn, Joohyuk; Park, Yeon Hee; Im, Young Hyuck; Ahn, Jin Hee; Kim, Sung‐Bae; Kim, Jee Hyun

doi:10.4143/crt.2015.475

Cited by 7 publications

(8 citation statements)

References 26 publications

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“…Lim et al [18] reported analyzed the data from 7,856 Korean women and reported that lower-inner quadrant tumors showed poor prognoses only in case of HER2 overexpression and triple-negative breast cancer. Some researchers have reported the prognostic value of nodal ratio after NAC, and have shown that this prognostic value is significant in certain molecular subtypes; however, the results are inconsistent [1920]. In the present study, we found that luminal A subtype breast cancer and a low nodal ratio conferred an OS advantage over the others; however, we could not identify any relationship between the molecular subtype and tumor location as well as nodal ratio.…”

Section: Discussioncontrasting

confidence: 81%

Prognostic Significance of Inner Quadrant Involvement in Breast Cancer Treated with Neoadjuvant Chemotherapy

et al. 2016

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PurposeIn the present study, we aimed to evaluate the initial tumor location as a prognostic factor in breast cancer patients treated with neoadjuvant chemotherapy (NAC).MethodsBetween March 2002 and January 2007, a total of 179 patients with stage II/III breast cancer underwent NAC followed by breast surgery. Using physical and radiologic findings, patients were grouped by their initial tumor location into inner/both quadrant (upper/lower inner quadrant involvement +/− multicentric tumor involving outer quadrant; n=97) and outer quadrant (n=82) tumor groups. All patients received neoadjuvant docetaxel/doxorubicin chemotherapy. One hundred two patients underwent modified radical mastectomy and 77 patients underwent breast-conserving surgery. Adjuvant radiotherapy (RT) and hormonal therapy were administered after surgery when indicated. While 156 patients underwent postoperative RT, 23 did not. The median follow-up duration was 61.1 (12–106) months.ResultsThe 5-year disease-free survival (DFS) and overall survival rates of all patients were 74.8% and 89.9%, respectively. Patients with inner/both quadrant tumors had lower 5-year DFS than those with outer quadrant tumors (67.7% vs. 83.4%, respectively; hazard ratio [HR]=1.941, p=0.034). A nodal ratio >25% was also an independent adverse prognostic factor for DFS (HR=3.276; p<0.001). There was no significant difference in DFS (p=0.592) after RT on the internal mammary node (IMN). Treatment failed in 44 out of 179 patients (24.6%), of which 27 patients had inner/both quadrant tumors. Twenty-one out of 27 patients had distant failures.ConclusionAmong breast cancer patients treated with NAC, those with inner/both quadrant tumors had lower DFS than those with outer quadrant tumors. More aggressive neoadjuvant and/or adjuvant chemotherapy with IMN RT is required for improved disease control and long-term survival.

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Section: Discussioncontrasting

confidence: 81%

Prognostic Significance of Inner Quadrant Involvement in Breast Cancer Treated with Neoadjuvant Chemotherapy

et al. 2016

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“…CE(A)F regimen chemotherapy has been the mainstay of NCT therapy for BC patients, however, the majority of patients will develop resistant, and ultimately recurrence [ 23 , 24 ]. It is our hope that this study will add to the body of literature for prediction the PI3K/PTEN/AKT pathway genetic polymorphisms lead to individual variation in response to CE(A)F regimen and prognosis.…”

Section: Discussionmentioning

confidence: 99%

The genetic variants in the PTEN/PI3K/AKT pathway predict susceptibility and CE(A)F chemotherapy response to breast cancer and clinical outcomes

Zhang

Liu

et al. 2017

Oncotarget

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The PI3K/PTEN/AKT pathway play a critical role in balancing cell growth and death. Epidemiologic studies suggested that mutations of the PI3K/PTEN/AKT pathway genes are associated with cancer risk, yet no data are available for PTEN rs701848, PIK3CA rs2699887, and AKT1 rs2494752 polymorphism and breast cancer(BC) risk. A case-control study was performed in 920 BC patients and 908 healthy controls using the TaqMan assay method. Overall, individuals with PTEN rs701848 TC, CC and TC/CC genotypes showed significant increased BC risk (P=0.043, P=0.002, P=0.008, respectively), and the C allele carriers had a 1.224-fold significantly increased risk of developing BC (P= 0.003). Moreover, a higher frequency of AKT rs2494752 AG genotype was observed among cases (P=0.045). Individuals harboring rs2494752 AG/AA genotype had a vital increased susceptibility to BC in the dominant model (P=0.039). More importantly, AKT1 rs2494752 GG genotype showed significantly rates of response to NCT chemotherapy (P=0.048). Furthermore, AKT1 rs2494752 AG genotype carriers showed significantly shorter DFS time, and GG genotype as the independent prognostic factor (DFS: adjusted HR=1.523, 95% CI=1.012-2.293, P=0.044; OS: adjusted HR=2.321, 95% CI=1.281-4.204, P=0.005). Moreover, MDR analysis consistently revealed that the combination of 3 selected SNPs and 7 known risk factors represented the best model to predicting BC prognosis. The luciferase assay showed that the G allele of rs2494752 significantly increased AKT1 promoter activity. These results suggest that PTEN rs701848 and AKT1 rs2494752 polymorphisms might be a candidate pharmacogenomic factor to assess the susceptibility of BC and response and prognosis prediction for interindividualized CE(A)F chemotherapy in BC patients.

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“…The prognostics of breast cancer patients after preoperative therapy had been discussed in several studies. [ 17 , 19 , 23 , 28 ] However, factors that independently and optimally reflect breast cancer patients’ survival who received PRT followed by MAST were still scarcely discussed. In the current study, we evaluated 1350 NMBC patients who received MAST after PRT and first developed a novel T-NR staging system.…”

Section: Discussionmentioning

confidence: 99%

“…[ 21 , 22 ] However, whether the mLNR was a better indicator than pN staging for breast cancer patients after preoperative therapy was still controversial. In 2016, Kim et al [ 23 ] conducted a multicenter retrospective study, and eventually they demonstrated that mLNR was not superior to pN staging in predicting clinical outcome of breast cancer after preoperative therapy.…”

Section: Discussionmentioning

confidence: 99%

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Using a novel T-lymph node ratio model to evaluate the prognosis of nonmetastatic breast cancer patients who received preoperative radiotherapy followed by mastectomy

et al. 2017

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We aimed to investigate the prognostic value of postpathological characters in nonmetastatic breast cancer (NMBC) patients who received preoperative radiotherapy (PRT) followed by mastectomy (MAST).We conducted retrospective analyses using the data collected from the Surveillance, Epidemiology, and End Results program of the National Cancer Institute. Univariate and multivariate analyses were performed to identify prognostic factors. Disease-specific survival was calculated by the Kaplan–Meier curve and validated by log rank test. The discriminations of independent risk factors and staging systems were compared by the area under receiver operating characteristic curves (AUC) and validated by Harrell concordance index (bootstrapping algorithm). Akaike information criterion (AIC) was applied to compare the difference of model.One thousand three hundred fifty NMBC patients who had received PRT followed by MAST from 1988 to 2013 were included in the study. We found the metastatic lymph node ratio (mLNR) staging was a superior indicator than pN staging. Thus, we proposed a T-lymph node ratio (T-NR) staging system with simplified-T categories (T0–3 and T4) and the mLNR staging. The novel T-NR staging system provided larger AUC (P = .024, .008, respectively) and the smaller AIC (P < .001) value than American Joint Committee on Cancer staging system.The novel T-NR staging system performed more accurate survival prediction and better model fitness for NMBC patients who receive PRT followed by MAST, it may provide a wide applicability in clinical decision-making.

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Prognostic Value of Axillary Nodal Ratio after Neoadjuvant Chemotherapy of Doxorubicin/Cyclophosphamide Followed by Docetaxel in Breast Cancer: A Multicenter Retrospective Cohort Study

Cited by 7 publications

References 26 publications

Prognostic Significance of Inner Quadrant Involvement in Breast Cancer Treated with Neoadjuvant Chemotherapy

Prognostic Significance of Inner Quadrant Involvement in Breast Cancer Treated with Neoadjuvant Chemotherapy

The genetic variants in the PTEN/PI3K/AKT pathway predict susceptibility and CE(A)F chemotherapy response to breast cancer and clinical outcomes

Using a novel T-lymph node ratio model to evaluate the prognosis of nonmetastatic breast cancer patients who received preoperative radiotherapy followed by mastectomy

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