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Bossuyt V, Provenzano E, Symmans WF, Webster F, Allison KH, Dang C, Gobbi H, Kulka J, Lakhani SR, Moriya T, Quinn CM, Sapino A, Schnitt S, Sibbering DM, Slodkowska E, Yang W, Tan PH, Ellis I. A dedicated structured data set for reporting of invasive carcinoma of the breast in the setting of neoadjuvant therapy: recommendations from the International Collaboration on Cancer Reporting (ICCR). Histopathology 2024; 84:1111-1129. [PMID: 38443320 DOI: 10.1111/his.15165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/11/2024] [Indexed: 03/07/2024]
Abstract
AIMS The International Collaboration on Cancer Reporting (ICCR), a global alliance of major (inter-)national pathology and cancer organisations, is an initiative aimed at providing a unified international approach to reporting cancer. ICCR recently published new data sets for the reporting of invasive breast carcinoma, surgically removed lymph nodes for breast tumours and ductal carcinoma in situ, variants of lobular carcinoma in situ and low-grade lesions. The data set in this paper addresses the neoadjuvant setting. The aim is to promote high-quality, standardised reporting of tumour response and residual disease after neoadjuvant treatment that can be used for subsequent management decisions for each patient. METHODS The ICCR convened expert panels of breast pathologists with a representative surgeon and oncologist to critically review and discuss current evidence. Feedback from the international public consultation was critical in the development of this data set. RESULTS The expert panel concluded that a dedicated data set was required for reporting of breast specimens post-neoadjuvant therapy with inclusion of data elements specific to the neoadjuvant setting as core or non-core elements. This data set proposes a practical approach for handling and reporting breast resection specimens following neoadjuvant therapy. The comments for each data element clarify terminology, discuss available evidence and highlight areas with limited evidence that need further study. This data set overlaps with, and should be used in conjunction with, the data sets for the reporting of invasive breast carcinoma and surgically removed lymph nodes from patients with breast tumours, as appropriate. Key issues specific to the neoadjuvant setting are included in this paper. The entire data set is freely available on the ICCR website. CONCLUSIONS High-quality, standardised reporting of tumour response and residual disease after neoadjuvant treatment are critical for subsequent management decisions for each patient.
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Affiliation(s)
- Veerle Bossuyt
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Elena Provenzano
- Department of Histopathology, Addenbrookes Hospital, Cambridge, UK
| | - W Fraser Symmans
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Fleur Webster
- International Collaboration on Cancer Reporting, Surry Hills, NSW, Australia
| | - Kimberly H Allison
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Chau Dang
- Memorial Sloan Kettering Cancer Center, West Harrison, NY, USA
| | - Helenice Gobbi
- Department of Surgical Clinic, Federal University of Triangulo Mineiro, Uberaba, MG, Brazil
| | - Janina Kulka
- Department of Pathology, Forensic and Insurance Medicine, Semmelweis University, Budapest, Hungary
| | - Sunil R Lakhani
- Centre for Clinical Research, and Pathology Queensland, University of Queensland, Brisbane, Qld, Australia
| | - Takuya Moriya
- Department of Pathology, Kawasaki Medical School, Okayama, Japan
| | - Cecily M Quinn
- Department of Histopathology, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College, Dublin, Ireland
| | - Anna Sapino
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Stuart Schnitt
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - D Mark Sibbering
- University Hospitals of Derby and Burton NHS Trust, Royal Derby Hospital, Derby, UK
| | - Elzbieta Slodkowska
- Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | | | - Ian Ellis
- Department of Histopathology, Nottingham City Hospital, London, UK
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Provenzano E, Shaaban AM. Pathology of neoadjuvant therapy and immunotherapy testing for breast cancer. Histopathology 2023; 82:170-188. [PMID: 36482270 DOI: 10.1111/his.14771] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 08/07/2022] [Accepted: 08/08/2022] [Indexed: 12/13/2022]
Abstract
Neoadjuvant chemotherapy (NACT) has become the standard of care for high-risk breast cancer, including triple-negative (TNBC) and HER2-positive disease. As a result, handling and reporting of breast specimens post-NACT is part of routine practice, and it is important for pathologists to recognise the changes in tumour cells, tumour-associated stroma and background breast tissue induced by NACT. Familiarity with characteristic stromal features enables identification of the pre-treatment tumour site and allows confident diagnosis of pathological complete response (pCR) which is important for decisions concerning adjuvant therapy. Neoadjuvant endocrine therapy (NAET) is used less frequently than NACT; however, the SARS-COVID-19 pandemic has changed practice, with increased use as bridging therapy if surgery is delayed. NAET also induces characteristic changes in the tumour and stroma. Changes in the tumour microenvironment following NACT and NAET are also described. Immunotherapy is approved for use in advanced TNBC, and there are several trials exploring its role in early TNBC in the neoadjuvant setting. The current biomarker to determine eligibility for treatment with immune checkpoint inhibitors is programmed death ligand-1 (PD-L1) immunohistochemistry; however, this is complicated by lack of standardisation with different drugs linked to tests using different antibodies with different scoring systems. The situation in the neoadjuvant setting is further complicated by improved pCR rates for PD-L1-positive tumours in both immune therapy and placebo arms. Alternative biomarkers are urgently needed to identify which patients will derive benefit from immunotherapy and key candidates are discussed.
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Affiliation(s)
- Elena Provenzano
- Department of Histopathology, Cambridge University Hospital NHS Foundation Trust and NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Abeer M Shaaban
- Queen Elizabeth Hospital Birmingham and University of Birmingham, Birmingham, UK
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Development, verification, and comparison of a risk stratification model integrating residual cancer burden to predict individual prognosis in early-stage breast cancer treated with neoadjuvant therapy. ESMO Open 2021; 6:100269. [PMID: 34537675 PMCID: PMC8455687 DOI: 10.1016/j.esmoop.2021.100269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/16/2021] [Accepted: 08/21/2021] [Indexed: 11/20/2022] Open
Abstract
Background A favorable model for predicting disease-free survival (DFS) and stratifying prognostic risk in breast cancer (BC) treated with neoadjuvant chemotherapy (NAC) is lacking. The aim of the current study was to formulate an excellent model specially for predicting prognosis in these patients. Patients and methods Between January 2012 and December 2015, 749 early-stage BC patients who received NAC in Xijing hospital were included. Patients were randomly assigned to a training cohort (n = 563) and an independent cohort (n = 186). A prognostic model was created and subsequently validated. Predictive performance and discrimination were further measured and compared with other models. Results Clinical American Joint Committee on Cancer stage, grade, estrogen receptor expression, human epidermal growth factor receptor 2 (HER2) status and treatment, Ki-67 expression, lymphovascular invasion, and residual cancer burden were identified as independent prognostic variables for BC treated with NAC. The C-index of the model consistently outperformed other available models as well as single independent factors with 0.78, 0.80, 0.75, 0.82, and 0.77 in the training cohort, independent cohort, luminal BC, HER2-positive BC, and triple-negative BC, respectively. With the optimal cut-off values (280 and 360) selected by X-tile, patients were categorized as low-risk (total points ≤280), moderate-risk (280 < total points ≤ 360), and high-risk (total points >360) groups presenting significantly different 5-year DFS of 89.9%, 56.9%, and 27.7%, respectively. Conclusions In patients with BC, the first model including residual cancer burden index was demonstrated to predict the survival of individuals with favorable performance and discrimination. Furthermore, the risk stratification generated by it could determine the risk level of recurrence in whole early-stage BC cohort and subtype-specific cohorts, help tailor personalized intensive treatment, and select comparable study cohort in clinical trials. Establishing the first risk stratification nomogram for BC treated with NAC and validate its performance in BC cohorts. Incorporating residual cancer burden index into predictive nomogram for the first time. Predictive model can be utilized to predict DFS for all early-stage BC treated with NAC. Performing a continuous rather than categorized model to predict individual survival. The risk stratification can be used to select comparable population in trial design.
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Determination of breast cancer prognosis after neoadjuvant chemotherapy: comparison of Residual Cancer Burden (RCB) and Neo-Bioscore. Br J Cancer 2021; 124:1421-1427. [PMID: 33558711 PMCID: PMC8039034 DOI: 10.1038/s41416-020-01251-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 12/02/2020] [Accepted: 12/17/2020] [Indexed: 12/24/2022] Open
Abstract
Background To compare RCB (Residual Cancer Burden) and Neo-Bioscore in terms of prognostic performance and see if adding pathological variables improve these scores. Methods We analysed 750 female patients with invasive breast cancer (BC) treated with neoadjuvant chemotherapy (NAC) at Institut Curie between 2002 and 2012. Scores were compared in global population and by BC subtype using Akaike information criterion (AIC), C-Index (concordance index), calibration curves and after adding lymphovascular invasion (LVI) and pre-/post-NAC TILs levels. Results RCB and Neo-Bioscore were significantly associated to disease-free and overall survival in global population and for triple-negative BC. RCB had the lowest AICs in every BC subtype, corresponding to a better prognostic performance. In global population, C-Index values were poor for RCB (0.66; CI [0.61–0.71]) and fair for Neo-Bioscore (0.70; CI [0.65–0.75]). Scores were well calibrated in global population, but RCB yielded better prognostic performances in each BC subtype. Concordance between the two scores was poor. Adding LVI and TILs improved the performance of both scores. Conclusions Although RCB and Neo-Bioscore had similar prognostic performances, RCB showed better performance in BC subtypes, especially in luminal and TNBC. By generating fewer prognostic categories, RCB enables an easier use in everyday clinical practice.
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Sasanpour P, Sandoughdaran S, Mosavi-Jarrahi A, Malekzadeh M. Predictors of Pathological Complete Response to Neoadjuvant Chemotherapy in Iranian Breast Cancer Patients. Asian Pac J Cancer Prev 2018; 19:2423-2427. [PMID: 30255695 PMCID: PMC6249452 DOI: 10.22034/apjcp.2018.19.9.2423] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Achievement of pathologic complete response (pCR) in breast cancer patients receiving neoadjuvant chemotherapy (NAC) is associated with both overall survival and disease-free survival. The aim of present study was to identify clinical and pathological factors associated with achieving pCR in Iranian breast cancer patients receiving NAC. Methods: A retrospective review of all breast cancer patients treated with neoadjuvant chemotherapy between April 2012 and September 2016 at our institution was performed; 207 cases were evaluable for analysis. pCR was defined as having no residual invasive tumor in the breast surgical specimen removed following neoadjuvant therapy. Results: In univariate analysis, factors associated with pCR were age less than 35 years (p = 0.03), absence of Lymphovascular invasion (LVI) (p = 0.002) and negative hormone receptor status (p = 0.003). Hormone receptor status (P = 0.01; OR, 2.45; CI, 1.20 - 4.99) and LVI (P = 0.001; OR, 0.22; CI, 0.10 - 0.46) remained predictive variables in multivariate analysis after correction for the other variables. Conclusions: In conclusion, the results of this study suggests that presence of Lymphovascular invasion and positive hormone receptor status are associated with poorer response to neoadjuvant chemotherapy in breast cancer patients.
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Affiliation(s)
- Pegah Sasanpour
- Department of Radiation Oncology, Shohada-e-Tajrish Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Hamy AS, Lam GT, Laas E, Darrigues L, Balezeau T, Guerin J, Livartowski A, Sadacca B, Pierga JY, Vincent-Salomon A, Coussy F, Becette V, Bonsang-Kitzis H, Rouzier R, Feron JG, Benchimol G, Laé M, Reyal F. Lymphovascular invasion after neoadjuvant chemotherapy is strongly associated with poor prognosis in breast carcinoma. Breast Cancer Res Treat 2018; 169:295-304. [PMID: 29374852 DOI: 10.1007/s10549-017-4610-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 12/06/2017] [Indexed: 12/28/2022]
Abstract
PURPOSE Few studies evaluated the prognostic value of the presence of lymphovascular invasion (LVI) after neoadjuvant chemotherapy (NAC) for breast cancer (BC). METHODS The association between LVI and survival was evaluated in a cohort of BC patients treated by NAC between 2002 and 2011. Five post-NAC prognostic scores (ypAJCC, RCB, CPS, CPS + EG and Neo-Bioscore) were evaluated and compared with or without the addition of LVI. RESULTS Out of 1033 tumors, LVI was present on surgical specimens in 29.2% and absent in 70.8% of the cases. Post-NAC LVI was associated with impaired disease-free survival (DFS) (HR 2.54; 95% CI 1.96-3.31; P < 0.001), and the magnitude of this effect depended on BC subtype (Pinteraction = 0.003), (luminal BC: HR 1.83; P = 0.003; triple negative BC: HR 3.73; P < 0.001; HER2-positive BC: HR 6.21; P < 0.001). Post-NAC LVI was an independent predictor of local relapse, distant metastasis, and overall survival; and increased the accuracy of all five post-NAC prognostic scoring systems. CONCLUSIONS Post-NAC LVI is a strong independent prognostic factor that: (i) should be systematically reported in pathology reports; (ii) should be used as stratification factor after NAC to propose inclusion in second-line trials or adjuvant treatment; (iii) should be included in post-NAC scoring systems.
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Affiliation(s)
- Anne-Sophie Hamy
- Translational Research Department, INSERM, U932, Immunity and Cancer, Residual Tumor & Response to Treatment Laboratory, RT2Lab, Institut Curie, PSL Research University, 26, rue d'Ulm, 75248, Paris, France
| | - Giang-Thanh Lam
- Department of Surgery, Institut Curie, PSL Research University, 26 rue d'Ulm, 75248, Paris, France.,Department of Gynecology and Obstetrics, Geneva University Hospitals, 30 bd de la Cluse, 1205, Geneva, Switzerland
| | - Enora Laas
- Department of Surgery, Institut Curie, PSL Research University, 26 rue d'Ulm, 75248, Paris, France
| | - Lauren Darrigues
- Department of Surgery, Institut Curie, PSL Research University, 26 rue d'Ulm, 75248, Paris, France
| | - Thomas Balezeau
- Department of Medical Informatics and Data, Institut Curie, PSL Research University, 26 rue d'Ulm, 75248, Paris, France
| | - Julien Guerin
- Department of Medical Informatics and Data, Institut Curie, PSL Research University, 26 rue d'Ulm, 75248, Paris, France
| | - Alain Livartowski
- Department of Medical Informatics and Data, Institut Curie, PSL Research University, 26 rue d'Ulm, 75248, Paris, France.,Department of Medical Oncology, Institut Curie, PSL Research University, 26 rue d'Ulm, 75248, Paris, France
| | - Benjamin Sadacca
- Translational Research Department, INSERM, U932, Immunity and Cancer, Residual Tumor & Response to Treatment Laboratory, RT2Lab, Institut Curie, PSL Research University, 26, rue d'Ulm, 75248, Paris, France
| | - Jean-Yves Pierga
- Department of Medical Oncology, Institut Curie, PSL Research University, 26 rue d'Ulm, 75248, Paris, France
| | - Anne Vincent-Salomon
- Department of Pathology, Institut Curie, PSL Research University, 26 rue d'Ulm, 75248, Paris, France
| | - Florence Coussy
- Department of Medical Oncology, Hôpital René Huguenin, 35, rue Dailly, 92210, Saint-Cloud, France
| | - Veronique Becette
- Department of Pathology, Hôpital René Huguenin, 35, rue Dailly, 92210, Saint-Cloud, France
| | - Hélène Bonsang-Kitzis
- Department of Surgery, Institut Curie, PSL Research University, 26 rue d'Ulm, 75248, Paris, France
| | - Roman Rouzier
- Department of Surgery, Hôpital René Huguenin, 35, rue Dailly, 92210, Saint-Cloud, France.,Equipe d'Accueil 7285, Risk and Safety in Clinical Medicine for Women and Perinatal Health, University Versailles-Saint-Quentin, 2 av de la source de la Bièvre, 78180, Montigny-Le-Bretonneux, France
| | - Jean-Guillaume Feron
- Department of Surgery, Institut Curie, PSL Research University, 26 rue d'Ulm, 75248, Paris, France
| | - Gabriel Benchimol
- Department of Surgery, Institut Curie, PSL Research University, 26 rue d'Ulm, 75248, Paris, France
| | - Marick Laé
- Department of Pathology, Institut Curie, PSL Research University, 26 rue d'Ulm, 75248, Paris, France
| | - Fabien Reyal
- Translational Research Department, INSERM, U932, Immunity and Cancer, Residual Tumor & Response to Treatment Laboratory, RT2Lab, Institut Curie, PSL Research University, 26, rue d'Ulm, 75248, Paris, France. .,Department of Surgery, Institut Curie, PSL Research University, 26 rue d'Ulm, 75248, Paris, France.
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7
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Naidoo K, Parham DM, Pinder SE. An audit of residual cancer burden reproducibility in a UK context. Histopathology 2016; 70:217-222. [PMID: 27496095 DOI: 10.1111/his.13054] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 08/02/2016] [Indexed: 12/23/2022]
Abstract
AIMS The residual cancer burden score (RCB) is currently the preferred quantification tool for assessing residual disease following neoadjuvant chemotherapy (NACT) in breast cancer clinical trials. This has been shown to be highly reproducible at the MD Anderson Cancer Centre, where it was developed originally. We wanted to evaluate RCB in a UK context, where macroscopic handling of tissue may differ between sites. METHODS AND RESULTS The pathology slides from 90 post-NACT patients from Guy's and St Thomas' NHS Foundation Trust and the Royal Bournemouth Hospital were reviewed independently by two specialist breast histopathologists who recalculated the RCB for each case. Data were collated and analysed statistically for interobserver reproducibility, for both numerical and categorical RCB. Overall, agreement between pathologists was 'good' [kappa = 0.775; 95% confidence interval (CI) = 0.668-0.882]. The overall concordance for continuous RCB score and for categorical RCB group was statistically significant (Spearman's correlation coefficient = 0.9497; 95% CI = 0.9235-0.9671; P < 0.0001 and Spearman's correlation coefficient = 0.9145; 95% CI = 0.8712-0.9437; P < 0.0001, respectively). Discordance could not be attributed to any one component of the RCB calculation. CONCLUSIONS These data suggest that the RCB score is reproducible in a UK context. Further data comparing it to other quantification systems is required, however, before any superiority can be established.
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Affiliation(s)
- Kalnisha Naidoo
- Department of Histopathology, St Thomas' Hospital, London, UK.,Institute of Cancer Research, London, UK.,Division of Cancer Studies, King's College London, Guy's Hospital, London, UK
| | - David M Parham
- Department of Histopathology, Royal Bournemouth Hospital, Bournemouth, UK
| | - Sarah E Pinder
- Department of Histopathology, St Thomas' Hospital, London, UK.,Division of Cancer Studies, King's College London, Guy's Hospital, London, UK
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Liu YL, Saraf A, Lee SM, Zhong X, Hibshoosh H, Kalinsky K, Connolly EP. Lymphovascular invasion is an independent predictor of survival in breast cancer after neoadjuvant chemotherapy. Breast Cancer Res Treat 2016; 157:555-64. [PMID: 27225388 DOI: 10.1007/s10549-016-3837-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 05/14/2016] [Indexed: 12/30/2022]
Abstract
Various prognostic indicators have been investigated in neoadjuvant chemotherapy (NAC)-treated invasive breast cancer (BC). Our study examines if lymphovascular invasion (LVI) is an independent predictor of survival in women receiving NAC. We performed a retrospective analysis in 166 women with operable invasive BC who underwent adriamycin- and taxane-based NAC between 2000 and 2013. The presence of LVI was noted in breast excisions following NAC. Associations between progression-free and overall survival and LVI and other clinicopathologic variables were assessed. Median follow-up was 31 months (range 1.4-153 months) with a total of 56 events and 24 deaths from any cause. LVI was found in 74 of 166 patients (45 %). In univariate analysis, the presence of LVI was associated with worse progression-free survival (HR 3.37, 95 % CI 1.87-6.06, p < 0.01) and overall survival (HR 4.35, 95 % CI 1.61-11.79, p < 0.01). In multivariate models adjusting for breast cancer subtype, LVI was significantly associated with a decrease in progression-free survival (HR 3.76, 95 % CI 2.07-6.83, p < 0.01) and overall survival (HR 5.70, 95 % CI 2.08-15.64, p < 0.01). When stratified by subtype, those with hormone receptor or HER2-positive BCs with no LVI had the most favorable progression-free and overall survival. Those with both LVI and triple-negative BC had the worst progression-free and overall survival. LVI is an important prognostic marker and is associated with worse clinical outcome in breast cancer patients receiving NAC.
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Affiliation(s)
- Ying L Liu
- Department of Medicine, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Anurag Saraf
- Department of Radiation Oncology, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Shing M Lee
- Department of Biostatistics, Columbia University School of Medicine, New York, NY, USA
| | - Xiaobo Zhong
- Department of Biostatistics, Columbia University School of Medicine, New York, NY, USA
| | - Hanina Hibshoosh
- Department of Pathology and Cell Biology, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Kevin Kalinsky
- Department of Medical Oncology, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Eileen P Connolly
- Department of Radiation Oncology, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA.
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Jebbink M, van Werkhoven E, Mandjes IAM, Wesseling J, Lips EH, Vrancken Peeters MJTDF, Loo CE, Sonke GS, Linn SC, Falo Zamora C, Rodenhuis S. The prognostic value of the neoadjuvant response index in triple-negative breast cancer: validation and comparison with pathological complete response as outcome measure. Breast Cancer Res Treat 2015. [PMID: 26210520 DOI: 10.1007/s10549-015-3510-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The Neoadjuvant response index (NRI) has been proposed as a simple measure of downstaging by neoadjuvant treatment in breast cancer. It was previously found to predict recurrence-free survival (RFS) in triple-negative (TN) breast cancer. It was at least as accurate as the standard binary system, the absence or presence of a pathological complete remission (pCR), which is the commonly employed outcome measure. The NRI was evaluated in an independent consecutive series of patients to validate the previous findings. Univariable and multivariable analyses were done to assess the predictive value of clinical parameters and of the NRI for RFS. We combined the original and validation series of patients to build a multivariable predictive model for RFS after neoadjuvant chemotherapy in TN breast cancer. The validation set (N = 108) confirmed that patients with a higher-than-median NRI (>0.7) had excellent RFS (P = 0.002), similar to that of patients who had achieved a pCR. Multivariable analysis in 191 patients showed that the NRI was a strong independent predictor of RFS (P = 0.0002), with N-stage (P = 0.001) and T-stage (P = 0.014) ranking second and third, respectively. Importantly, among patients who did not achieve a pCR (NRI values below 1), higher NRI values were still associated with better RFS. The NRI is a simple method and a practical tool to predict RFS in TN breast cancer patients treated with neoadjuvant chemotherapy. It adds prognostic information to the presence or absence of pCR and could be useful to compare the efficacies of different chemotherapy regimens.
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Affiliation(s)
- M Jebbink
- Department of Medical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
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