The Effect of Molecular Subtype and Residual Disease on Locoregional Recurrence in Breast Cancer Patients Treated with Neoadjuvant Chemotherapy and Postmastectomy Radiation.

Abstract

BACKGROUND:

The relative contribution of biologic subtype to locoregional recurrence (LRR) in patients treated with neoadjuvant chemotherapy (NAC), mastectomy, and postmastectomy radiotherapy (PMRT) is not clearly defined.

METHODS:

233 patients with stages 2 and 3 breast cancer who received NAC, mastectomy, and PMRT between 2000 and 2009 were included: 53 % (n = 123) had HR+ (ER or PR+/HER2-), 23 % (n = 53) had HER2+ (HER2+/HR+ or HR-), and 24 % (n = 57) had triple-negative (TN) disease (HR-/HER2-). The 5-year LRR rates were estimated by Kaplan-Meier methods. Cox regression analysis was performed to evaluate covariates associated with LRR.

RESULTS:

The median follow-up period was 62 months. A pathologic complete response (pCR) was seen in 14 % of the patients. The 5-year LRR rate was 8 % for the entire cohort. The LRR rate was 0 % for the patients with a pCR versus 9 % for the patients without a pCR (p = 0.05). TN disease [Hazard ratio (HR) 4.4; p = 0.003] and pathologic node positivity (HR 9.8; p = 0.03) were associated with LRR. Patients with TN disease had a higher LRR rate than patients with HER2+ or HR+ disease (20 vs. 6 and 4 %; p = 0.005). Among patients without a pCR, TN subtype was associated with increased LRR risk (26 versus 7 % HER+ and 4 % HR+; p < 0.001).

CONCLUSIONS:

Patients with TN breast cancer had the highest LRR rate after NAC, mastectomy and PMRT. Whereas no LRR was observed among TN patients with a pCR, TN patients with residual disease had a significantly higher LRR risk. Patients with HR+ and HER2+ breast cancer had favorable LRR rates regardless of NAC response, likely due to receipt of adjuvant systemic targeted therapies.

• Authors: T Jonathan Yang, Monica Morrow, Shanu Modi, Zhigang Zhang, Kate Krause, Chun Siu, Beryl McCormick, Simon N Powell, Alice Y Ho
• Journal: Annals of surgical oncology (Ann Surg Oncol) Vol. 22 Suppl 3 Pg. S495-501 (Dec 2015) ISSN: 1534-4681 [Electronic] United States
• PMID: 26130454 (Publication Type: Journal Article)

Chemical References

• Biomarkers, Tumor
• Receptors, Estrogen
• Receptors, Progesterone
• ERBB2 protein, human
• Receptor, ErbB-2

Topics

• Adult
• Aged
• Aged, 80 and over
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Biomarkers, Tumor (metabolism)
• Breast Neoplasms (metabolism, pathology, therapy)
• Carcinoma, Ductal, Breast (metabolism, pathology, therapy)
• Carcinoma, Lobular (metabolism, pathology, therapy)
• Combined Modality Therapy
• Female
• Follow-Up Studies
• Humans
• Immunoenzyme Techniques
• Lymph Node Excision
• Mastectomy
• Middle Aged
• Neoadjuvant Therapy
• Neoplasm Invasiveness
• Neoplasm Recurrence, Local (diagnosis)
• Neoplasm Staging
• Neoplasm, Residual (metabolism, pathology, therapy)
• Prognosis
• Radiotherapy, Adjuvant
• Receptor, ErbB-2 (metabolism)
• Receptors, Estrogen (metabolism)
• Receptors, Progesterone (metabolism)
• Survival Rate
• Young Adult