Prognostic Factors in Operable Breast Cancer Treated with Neoadjuvant Chemotherapy: Towards a Quantification of Residual Disease
Objective: Neoadjuvant chemotherapy (NACT) allows for a more frequent use of breast-conservative surgery; it is also an in vivo model of individual tumor sensitivity which permits to determine new prognostic factors to personalize the therapeutic approach. Methods: Between 2000 and 2012, 318 patient...
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| Veröffentlicht in: | Oncology 2015-04, Vol.88 (5), p.261-272 |
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| creator | Mombelli, Sarah Kwiatkowski, Fabrice Abrial, Catherine Wang-Lopez, Qian de Boissieu, Paul Garbar, Christian Bensussan, Armand Curé, Hervé |
| description | Objective: Neoadjuvant chemotherapy (NACT) allows for a more frequent use of breast-conservative surgery; it is also an in vivo model of individual tumor sensitivity which permits to determine new prognostic factors to personalize the therapeutic approach. Methods: Between 2000 and 2012, 318 patients with primary invasive breast cancer were treated with a median of 6 cycles of NACT; they received either an anthracycline-based FEC 100 protocol (31.1%), or anthracyclines + taxanes (53.5%), with trastuzumab if indicated (15.4%). Results: After a median follow-up of 44.2 months, the pathological complete response rate according to the classification of Chevallier et al. [Am J Clin Oncol 1993;16:223-228] was 19.3%, and overall (OS) and disease-free survival (DFS) at 10 years were 60.2 and 69.6%, respectively. Univariate analyses demonstrated that the Residual Disease in Breast and Nodes (RDBN) index was the most significant prognostic factor for OS (p = 0.0082) and DFS (p = 0.0022), and multivariate analyses mainly revealed that the residual tumor size, residual involved node number and post-chemotherapy Scarff-Bloom-Richardson (SBR) grading were the most significant prognostic factors. Conclusions: In a cohort of patients who were all homogeneously treated with some of the most common drugs for breast cancer, we demonstrate that NACT may provide additional prognostic factors and confirm the RDBN index. As this index allows for the prediction of survival with different breast cancer subtypes, we suggest that it should be calculated routinely to help clinicians to select patients who need adjuvant treatments. |
| doi_str_mv | 10.1159/000368557 |
| format | Article |
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Methods: Between 2000 and 2012, 318 patients with primary invasive breast cancer were treated with a median of 6 cycles of NACT; they received either an anthracycline-based FEC 100 protocol (31.1%), or anthracyclines + taxanes (53.5%), with trastuzumab if indicated (15.4%). Results: After a median follow-up of 44.2 months, the pathological complete response rate according to the classification of Chevallier et al. [Am J Clin Oncol 1993;16:223-228] was 19.3%, and overall (OS) and disease-free survival (DFS) at 10 years were 60.2 and 69.6%, respectively. Univariate analyses demonstrated that the Residual Disease in Breast and Nodes (RDBN) index was the most significant prognostic factor for OS (p = 0.0082) and DFS (p = 0.0022), and multivariate analyses mainly revealed that the residual tumor size, residual involved node number and post-chemotherapy Scarff-Bloom-Richardson (SBR) grading were the most significant prognostic factors. Conclusions: In a cohort of patients who were all homogeneously treated with some of the most common drugs for breast cancer, we demonstrate that NACT may provide additional prognostic factors and confirm the RDBN index. As this index allows for the prediction of survival with different breast cancer subtypes, we suggest that it should be calculated routinely to help clinicians to select patients who need adjuvant treatments.</description><identifier>ISSN: 0030-2414</identifier><identifier>EISSN: 1423-0232</identifier><identifier>DOI: 10.1159/000368557</identifier><identifier>PMID: 25573741</identifier><language>eng</language><publisher>Basel, Switzerland: S. Karger AG</publisher><subject><![CDATA[Adjuvant treatment ; Adult ; Aged ; Aged, 80 and over ; Anthracyclines - administration & dosage ; Antineoplastic Combined Chemotherapy Protocols - administration & dosage ; Antineoplastic Combined Chemotherapy Protocols - therapeutic use ; Breast cancer ; Breast Neoplasms - drug therapy ; Breast Neoplasms - epidemiology ; Breast Neoplasms - pathology ; Breast Neoplasms - surgery ; Cancer ; Carcinoma, Ductal, Breast - drug therapy ; Carcinoma, Ductal, Breast - epidemiology ; Carcinoma, Ductal, Breast - pathology ; Carcinoma, Ductal, Breast - surgery ; Chemotherapy ; Chemotherapy, Adjuvant ; Clinical Study ; Confounding Factors (Epidemiology) ; Cyclophosphamide - administration & dosage ; Development and progression ; Disease-Free Survival ; Drug Administration Schedule ; Drug therapy ; Epirubicin - administration & dosage ; Female ; Fluorouracil - administration & dosage ; Follow-Up Studies ; France - epidemiology ; Humans ; Kaplan-Meier Estimate ; Lymphatic Metastasis ; Mastectomy, Segmental ; Medical prognosis ; Metastasis ; Middle Aged ; Neoadjuvant Therapy - methods ; Neoplasm Staging ; Neoplasm, Residual - epidemiology ; Patient outcomes ; Prognosis ; Retrospective Studies ; Risk Factors ; Taxoids - administration & dosage ; Treatment Outcome]]></subject><ispartof>Oncology, 2015-04, Vol.88 (5), p.261-272</ispartof><rights>2015 S. Karger AG, Basel</rights><rights>COPYRIGHT 2015 S. Karger AG</rights><rights>Copyright (c) 2015 S. Karger AG, Basel</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c502t-d559aeebe8c7fa4adc27b0b5e5ed0d5aced976c2def54d75e9b22e21bbdf92283</citedby><cites>FETCH-LOGICAL-c502t-d559aeebe8c7fa4adc27b0b5e5ed0d5aced976c2def54d75e9b22e21bbdf92283</cites><orcidid>0000-0003-4654-7610</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,2428,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25573741$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mombelli, Sarah</creatorcontrib><creatorcontrib>Kwiatkowski, Fabrice</creatorcontrib><creatorcontrib>Abrial, Catherine</creatorcontrib><creatorcontrib>Wang-Lopez, Qian</creatorcontrib><creatorcontrib>de Boissieu, Paul</creatorcontrib><creatorcontrib>Garbar, Christian</creatorcontrib><creatorcontrib>Bensussan, Armand</creatorcontrib><creatorcontrib>Curé, Hervé</creatorcontrib><title>Prognostic Factors in Operable Breast Cancer Treated with Neoadjuvant Chemotherapy: Towards a Quantification of Residual Disease</title><title>Oncology</title><addtitle>Oncology</addtitle><description>Objective: Neoadjuvant chemotherapy (NACT) allows for a more frequent use of breast-conservative surgery; it is also an in vivo model of individual tumor sensitivity which permits to determine new prognostic factors to personalize the therapeutic approach. Methods: Between 2000 and 2012, 318 patients with primary invasive breast cancer were treated with a median of 6 cycles of NACT; they received either an anthracycline-based FEC 100 protocol (31.1%), or anthracyclines + taxanes (53.5%), with trastuzumab if indicated (15.4%). Results: After a median follow-up of 44.2 months, the pathological complete response rate according to the classification of Chevallier et al. [Am J Clin Oncol 1993;16:223-228] was 19.3%, and overall (OS) and disease-free survival (DFS) at 10 years were 60.2 and 69.6%, respectively. Univariate analyses demonstrated that the Residual Disease in Breast and Nodes (RDBN) index was the most significant prognostic factor for OS (p = 0.0082) and DFS (p = 0.0022), and multivariate analyses mainly revealed that the residual tumor size, residual involved node number and post-chemotherapy Scarff-Bloom-Richardson (SBR) grading were the most significant prognostic factors. Conclusions: In a cohort of patients who were all homogeneously treated with some of the most common drugs for breast cancer, we demonstrate that NACT may provide additional prognostic factors and confirm the RDBN index. As this index allows for the prediction of survival with different breast cancer subtypes, we suggest that it should be calculated routinely to help clinicians to select patients who need adjuvant treatments.</description><subject>Adjuvant treatment</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anthracyclines - administration & dosage</subject><subject>Antineoplastic Combined Chemotherapy Protocols - administration & dosage</subject><subject>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</subject><subject>Breast cancer</subject><subject>Breast Neoplasms - drug therapy</subject><subject>Breast Neoplasms - epidemiology</subject><subject>Breast Neoplasms - pathology</subject><subject>Breast Neoplasms - surgery</subject><subject>Cancer</subject><subject>Carcinoma, Ductal, Breast - drug therapy</subject><subject>Carcinoma, Ductal, Breast - epidemiology</subject><subject>Carcinoma, Ductal, Breast - pathology</subject><subject>Carcinoma, Ductal, Breast - surgery</subject><subject>Chemotherapy</subject><subject>Chemotherapy, Adjuvant</subject><subject>Clinical Study</subject><subject>Confounding Factors (Epidemiology)</subject><subject>Cyclophosphamide - administration & dosage</subject><subject>Development and progression</subject><subject>Disease-Free Survival</subject><subject>Drug Administration Schedule</subject><subject>Drug therapy</subject><subject>Epirubicin - administration & dosage</subject><subject>Female</subject><subject>Fluorouracil - administration & dosage</subject><subject>Follow-Up Studies</subject><subject>France - epidemiology</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Lymphatic Metastasis</subject><subject>Mastectomy, Segmental</subject><subject>Medical prognosis</subject><subject>Metastasis</subject><subject>Middle Aged</subject><subject>Neoadjuvant Therapy - methods</subject><subject>Neoplasm Staging</subject><subject>Neoplasm, Residual - epidemiology</subject><subject>Patient outcomes</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Taxoids - administration & dosage</subject><subject>Treatment Outcome</subject><issn>0030-2414</issn><issn>1423-0232</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNpt0kFv0zAUAGALgVg3OHBHyBISgkOGY8dxstsoDJAmBqicoxf7pXVJ4mI7m3bjp-OqpTCEfLD83veebOsR8iRnp3ku69eMMVFWUqp7ZJYXXGSMC36fzFKYZbzIiyNyHMI6MSWL8iE54skKVeQz8vOzd8vRhWg1vQAdnQ_UjvRqgx7aHukbjxAincOo0dNFOkU09MbGFf2EDsx6uoYx5Vc4uLhKRZvbM7pwN-BNoEC_TClrO6shWjdS19GvGKyZoKdvbUit8RF50EEf8PF-PyHfLt4t5h-yy6v3H-fnl5mWjMfMSFkDYouVVh0UYDRXLWslSjTMSNBoalVqbrCThVES65Zz5Hnbmq7mvBIn5OWu78a7HxOG2Aw2aOx7GNFNoclLpaqaCbGlz_-hazf5Md0uqaouy1xUxR-1hB4bO3YuetDbps15KZSopax4Uqf_UWkZHKx2I3Y2xe8UvPirYIXQx1Vw_bT9v3AXvtpB7V0IHrtm4-0A_rbJWbMdi-YwFsk-279oagc0B_l7DhJ4ugPfwS_RH8C-_hdwCrro</recordid><startdate>20150401</startdate><enddate>20150401</enddate><creator>Mombelli, Sarah</creator><creator>Kwiatkowski, Fabrice</creator><creator>Abrial, Catherine</creator><creator>Wang-Lopez, Qian</creator><creator>de Boissieu, Paul</creator><creator>Garbar, Christian</creator><creator>Bensussan, Armand</creator><creator>Curé, Hervé</creator><general>S. 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administration & dosage</topic><topic>Antineoplastic Combined Chemotherapy Protocols - administration & dosage</topic><topic>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</topic><topic>Breast cancer</topic><topic>Breast Neoplasms - drug therapy</topic><topic>Breast Neoplasms - epidemiology</topic><topic>Breast Neoplasms - pathology</topic><topic>Breast Neoplasms - surgery</topic><topic>Cancer</topic><topic>Carcinoma, Ductal, Breast - drug therapy</topic><topic>Carcinoma, Ductal, Breast - epidemiology</topic><topic>Carcinoma, Ductal, Breast - pathology</topic><topic>Carcinoma, Ductal, Breast - surgery</topic><topic>Chemotherapy</topic><topic>Chemotherapy, Adjuvant</topic><topic>Clinical Study</topic><topic>Confounding Factors (Epidemiology)</topic><topic>Cyclophosphamide - administration & dosage</topic><topic>Development and progression</topic><topic>Disease-Free Survival</topic><topic>Drug Administration Schedule</topic><topic>Drug therapy</topic><topic>Epirubicin - administration & dosage</topic><topic>Female</topic><topic>Fluorouracil - administration & dosage</topic><topic>Follow-Up Studies</topic><topic>France - epidemiology</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Lymphatic Metastasis</topic><topic>Mastectomy, Segmental</topic><topic>Medical prognosis</topic><topic>Metastasis</topic><topic>Middle Aged</topic><topic>Neoadjuvant Therapy - methods</topic><topic>Neoplasm Staging</topic><topic>Neoplasm, Residual - epidemiology</topic><topic>Patient outcomes</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Taxoids - administration & dosage</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mombelli, Sarah</creatorcontrib><creatorcontrib>Kwiatkowski, Fabrice</creatorcontrib><creatorcontrib>Abrial, Catherine</creatorcontrib><creatorcontrib>Wang-Lopez, Qian</creatorcontrib><creatorcontrib>de Boissieu, Paul</creatorcontrib><creatorcontrib>Garbar, Christian</creatorcontrib><creatorcontrib>Bensussan, Armand</creatorcontrib><creatorcontrib>Curé, Hervé</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mombelli, Sarah</au><au>Kwiatkowski, Fabrice</au><au>Abrial, Catherine</au><au>Wang-Lopez, Qian</au><au>de Boissieu, Paul</au><au>Garbar, Christian</au><au>Bensussan, Armand</au><au>Curé, Hervé</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prognostic Factors in Operable Breast Cancer Treated with Neoadjuvant Chemotherapy: Towards a Quantification of Residual Disease</atitle><jtitle>Oncology</jtitle><addtitle>Oncology</addtitle><date>2015-04-01</date><risdate>2015</risdate><volume>88</volume><issue>5</issue><spage>261</spage><epage>272</epage><pages>261-272</pages><issn>0030-2414</issn><eissn>1423-0232</eissn><abstract>Objective: Neoadjuvant chemotherapy (NACT) allows for a more frequent use of breast-conservative surgery; it is also an in vivo model of individual tumor sensitivity which permits to determine new prognostic factors to personalize the therapeutic approach. Methods: Between 2000 and 2012, 318 patients with primary invasive breast cancer were treated with a median of 6 cycles of NACT; they received either an anthracycline-based FEC 100 protocol (31.1%), or anthracyclines + taxanes (53.5%), with trastuzumab if indicated (15.4%). Results: After a median follow-up of 44.2 months, the pathological complete response rate according to the classification of Chevallier et al. [Am J Clin Oncol 1993;16:223-228] was 19.3%, and overall (OS) and disease-free survival (DFS) at 10 years were 60.2 and 69.6%, respectively. Univariate analyses demonstrated that the Residual Disease in Breast and Nodes (RDBN) index was the most significant prognostic factor for OS (p = 0.0082) and DFS (p = 0.0022), and multivariate analyses mainly revealed that the residual tumor size, residual involved node number and post-chemotherapy Scarff-Bloom-Richardson (SBR) grading were the most significant prognostic factors. Conclusions: In a cohort of patients who were all homogeneously treated with some of the most common drugs for breast cancer, we demonstrate that NACT may provide additional prognostic factors and confirm the RDBN index. As this index allows for the prediction of survival with different breast cancer subtypes, we suggest that it should be calculated routinely to help clinicians to select patients who need adjuvant treatments.</abstract><cop>Basel, Switzerland</cop><pub>S. Karger AG</pub><pmid>25573741</pmid><doi>10.1159/000368557</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0003-4654-7610</orcidid></addata></record> |
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| ispartof | Oncology, 2015-04, Vol.88 (5), p.261-272 |
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| source | MEDLINE; Karger Journals |
| subjects | Adjuvant treatment Adult Aged Aged, 80 and over Anthracyclines - administration & dosage Antineoplastic Combined Chemotherapy Protocols - administration & dosage Antineoplastic Combined Chemotherapy Protocols - therapeutic use Breast cancer Breast Neoplasms - drug therapy Breast Neoplasms - epidemiology Breast Neoplasms - pathology Breast Neoplasms - surgery Cancer Carcinoma, Ductal, Breast - drug therapy Carcinoma, Ductal, Breast - epidemiology Carcinoma, Ductal, Breast - pathology Carcinoma, Ductal, Breast - surgery Chemotherapy Chemotherapy, Adjuvant Clinical Study Confounding Factors (Epidemiology) Cyclophosphamide - administration & dosage Development and progression Disease-Free Survival Drug Administration Schedule Drug therapy Epirubicin - administration & dosage Female Fluorouracil - administration & dosage Follow-Up Studies France - epidemiology Humans Kaplan-Meier Estimate Lymphatic Metastasis Mastectomy, Segmental Medical prognosis Metastasis Middle Aged Neoadjuvant Therapy - methods Neoplasm Staging Neoplasm, Residual - epidemiology Patient outcomes Prognosis Retrospective Studies Risk Factors Taxoids - administration & dosage Treatment Outcome |
| title | Prognostic Factors in Operable Breast Cancer Treated with Neoadjuvant Chemotherapy: Towards a Quantification of Residual Disease |
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