PREDICTORS OF RECCURENCE IN BREAST CANCER PATIENTS WITH pCR WITH NEOADJUVANT THERAPY

Br J Cancer. 2010 Jul 6. [Epub ahead of print]
Predictors of recurrence in breast cancer patients with a pathologic complete response after neoadjuvant chemotherapy.
Tanioka M, Shimizu C, Yonemori K, Yoshimura K, Tamura K, Kouno T, Ando M, Katsumata N, Tsuda H, Kinoshita T, Fujiwara Y.

[1] Breast and Medical Oncology Division, National Cancer Center Hospital, Tokyo, Japan [2] Medical Oncology Division, Hyogo Cancer Center, Hyogo, Japan.
Abstract

Background:Although a pathologic complete response (pCR) after neoadjuvant chemotherapy is associated with favourable outcomes, a small proportion of patients with pCR have recurrence. This study was designed to identify factors predictive of recurrence in patients with pCR.Methods:A total of 449 breast cancer patients received neoadjuvant chemotherapy, and 88 evaluable patients had a pCR, defined as no evidence of invasive carcinoma in the breast at surgery. The clinical stage was II in 61 patients (69%), III in 27 (31%). All patients received taxanes and 92% received anthracyclines. Among 43 patients with HER2-positive tumours, 27 received trastuzumab. Cox regression analyses were performed to identify predictors of recurrence.Results:Median follow-up was 46.0 months. There were 12 recurrences, including 8 distant metastases. The rate of locoregional recurrence was 10.4% after breast-conserving surgery, as compared with 2.5% after mastectomy. Multivariate analysis revealed that axillary metastases (hazard ratio (HR), 13.6; P<0.0001) and HER2-positive disease (HR, 5.0; P<0.019) were significant predictors of recurrence. Five of six patients with both factors had recurrence. Inclusion of trastuzumab was not an independent predictor among patients with HER2-positive breast cancer.Conclusion:Our study results suggest that HER2 status and axillary metastases are independent predictors of recurrence in patients with pCR.British Journal of Cancer advance online publication, 6 July 2010; doi:10.1038/sj.bjc.6605769.