Combining Clinical and Pathologic Staging Variables Has Prognostic Value in Predicting Local-regional Recurrence Following Neoadjuvant Chemotherapy for Breast Cancer.

Abstract

OBJECTIVE:

The current study was undertaken to determine if the CPS+EG score could stratify patients with respect to local-regional recurrence (LRR).

BACKGROUND:

We previously defined and validated a novel breast cancer staging system incorporating the American Joint Committee on Cancer clinical stage (CS), final pathologic stage (PS), estrogen receptor status (E), and nuclear grade (G) (CPS+EG score). The score is associated with disease-specific survival outcomes in patients treated with neoadjuvant chemotherapy.

METHODS:

Patients receiving neoadjuvant chemotherapy between 1997 and 2005 were identified and clinicopathologic data were used to determine the CPS+EG score. Type of local therapy, breast-conserving therapy, mastectomy alone, or mastectomy followed by postmastectomy radiation therapy was recorded. Multivariate analysis, including CPS+EG score and local therapy, was performed to evaluate for association with LRR.

RESULTS:

Of 1697 patients, breast conserving therapy was performed in 656 (39%), mastectomy in 297 (17%) and mastectomy + postmastectomy radiation therapy in 744 (44%). At a median follow-up of 49 months, the crude incidence of LRR was 6.5%. Freedom from LRR at 5 years ranged from 86% to 97% by clinical stage, 86% to 97% by pathologic stage, and 71% to 99% by CPS+EG score. On multivariate analysis, CPS+EG score and surgery type were independently associated with LRR, with increased risk among patients with CPS+EG scores of 3 or greater (HR 1.94, 95% CI 1.04-3.63) or mastectomy alone (HR 2.14, 95% CI 1.26-3.63).

CONCLUSIONS:

The CPS+EG staging system better stratifies patients with respect to LRR after neoadjuvant chemotherapy than presenting clinical stage or final pathologic stage. For CPS+EG scores ≥3, use of postmastectomy radiation therapy decreases the likelihood of LRR after mastectomy.

• Authors: Jose Vila, Mediget Teshome, Susan L Tucker, Wendy A Woodward, Mariana Chavez-MacGregor, Kelly K Hunt, Elizabeth A Mittendorf
• Journal: Annals of surgery (Ann Surg) Vol. 265 Issue 3 Pg. 574-580 (03 2017) ISSN: 1528-1140 [Electronic] United States
• PMID: 27735826 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't, Research Support, N.I.H., Extramural)

Topics

• Academic Medical Centers
• Adult
• Aged
• Aged, 80 and over
• Breast Neoplasms (drug therapy, mortality, pathology, surgery)
• Chemotherapy, Adjuvant
• Cohort Studies
• Databases, Factual
• Disease-Free Survival
• Female
• Humans
• Incidence
• Kaplan-Meier Estimate
• Mastectomy (methods)
• Middle Aged
• Multivariate Analysis
• Neoadjuvant Therapy (methods)
• Neoplasm Invasiveness (pathology)
• Neoplasm Recurrence, Local (mortality, pathology, therapy)
• Neoplasm Staging
• Predictive Value of Tests
• Proportional Hazards Models
• Retrospective Studies
• Risk Assessment
• Survival Analysis
• Treatment Outcome