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Meneveau MO, Crawford MP, Turkheimer LM, Millard TA, Atkins KA, Showalter SL. The POWER-PAK Score Characterizes Tumor Response to 3 Months of Preoperative Endocrine Therapy. Ann Surg Oncol 2023; 30:6034-6040. [PMID: 37454014 PMCID: PMC10766409 DOI: 10.1245/s10434-023-13892-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The Pre-Operative Window of Endocrine Therapy to Inform Radiation Therapy Decisions (POWER, NCT04272801) trial aims to determine whether 3 months of preoperative endocrine therapy (pre-ET) informs adjuvant radiation therapy decisions among older women with early stage, ER-positive breast cancer. We propose the POWER Pathologic Assessment and Ki-67 (POWER-PAK) scoring system to characterize the histologic effects of pre-ET. METHODS Histologic evaluation was performed on core biopsy and lumpectomy specimens from 37 POWER trial participants who completed pre-ET and surgery. The POWER-PAK score consists of tumor regression, decrease in Ki-67 expression, and ER expression, each ranging from 0 to 2. Scores were aggregated to create the POWER-PAK score with a range from 0 to 6. Participants with no residual tumor were labelled 6-NRT. RESULTS ER expression did not decrease after pre-ET. Ki-67 decreased from 13% in biopsy specimens to 5% in the lumpectomy specimens (p < 0.001). Cellularity decreased from 40% to 23% (p < 0.001). There was heterogeneity of POWER-PAK scores ranging from 2 to 6-NRT: score of 2, n = 2 (5.4%); 4, n = 8 (21.6%); 5, n = 4 (10.8%); 6, n = 16 (43.2%); and 6-NRT, n = 7 (18.9%). Participants with a score ≥ 5 were more likely to have smaller tumors after pre-ET compared with those with a score < 5 (p = 0.04). CONCLUSIONS The tumor responses following treatment with pre-ET are heterogenous. We propose that the POWER-PAK scoring system can be used to quantify response to pre-ET. Future studies will explore the use of POWER-PAK to support informed decision-making for adjuvant therapy options for older women with early stage breast cancer.
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Affiliation(s)
- Max O Meneveau
- Department of Surgery, Division of Breast and Melanoma Surgery, University of Virginia, Charlottesville, VA, USA
| | - Michael P Crawford
- Department of Pathology, University of Virginia, Charlottesville, VA, USA
| | - Lena M Turkheimer
- Department of Surgery, Division of Breast and Melanoma Surgery, University of Virginia, Charlottesville, VA, USA
| | - Trish A Millard
- Department of Medicine, Division of Hematology/Oncology, University of Virginia, Charlottesville, VA, USA
| | - Kristen A Atkins
- Department of Pathology, University of Virginia, Charlottesville, VA, USA
| | - Shayna L Showalter
- Department of Surgery, Division of Breast and Melanoma Surgery, University of Virginia, Charlottesville, VA, USA.
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Yu FH, Miao SM, Li CY, Hang J, Deng J, Ye XH, Liu Y. Pretreatment ultrasound-based deep learning radiomics model for the early prediction of pathologic response to neoadjuvant chemotherapy in breast cancer. Eur Radiol 2023; 33:5634-5644. [PMID: 36976336 DOI: 10.1007/s00330-023-09555-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 02/09/2023] [Accepted: 02/19/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVES To investigate the predictive performance of the deep learning radiomics (DLR) model integrating pretreatment ultrasound imaging features and clinical characteristics for evaluating therapeutic response after neoadjuvant chemotherapy (NAC) in patients with breast cancer. METHODS A total of 603 patients who underwent NAC were retrospectively included between January 2018 and June 2021 from three different institutions. Four different deep convolutional neural networks (DCNNs) were trained by pretreatment ultrasound images using annotated training dataset (n = 420) and validated in a testing cohort (n = 183). Comparing the predictive performance of these models, the best one was selected for image-only model structure. Furthermore, the integrated DLR model was constructed based on the image-only model combined with independent clinical-pathologic variables. Areas under the curve (AUCs) of these models and two radiologists were compared by using the DeLong method. RESULTS As the optimal basic model, Resnet50 achieved an AUC and accuracy of 0.879 and 82.5% in the validation set. The integrated DLR model, yielding the highest classification performance in predicting response to NAC (AUC 0.962 and 0.939 in the training and validation cohort), outperformed the image-only model and the clinical model and also performed better than two radiologists' prediction (all p < 0.05). In addition, predictive efficacy of the radiologists was improved under the assistance of the DLR model significantly. CONCLUSION The pretreatment US-based DLR model could hold promise as a clinical guidance for predicting NAC response of patients with breast cancer, thereby providing benefit of timely treatment strategy adjustment to potential poor NAC responders. KEY POINTS • Multicenter retrospective study showed that deep learning radiomics (DLR) model based on pretreatment ultrasound image and clinical parameter achieved satisfactory prediction of tumor response to neoadjuvant chemotherapy (NAC) in breast cancer. • The integrated DLR model could become an effective tool to guide clinicians in identifying potential poor pathological responders before chemotherapy. • The predictive efficacy of the radiologists was improved under the assistance of the DLR model.
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Affiliation(s)
- Fei-Hong Yu
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shu-Mei Miao
- Department of Information, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Department of Medical Informatics, School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China
| | - Cui-Ying Li
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jing Hang
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jing Deng
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xin-Hua Ye
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yun Liu
- Department of Information, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
- Department of Medical Informatics, School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China.
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Wang X, Hua H, Han J, Zhong X, Liu J, Chen J. Evaluation of Multiparametric MRI Radiomics-Based Nomogram in Prediction of Response to Neoadjuvant Chemotherapy in Breast Cancer: A Two-Center study. Clin Breast Cancer 2023:S1526-8209(23)00134-9. [PMID: 37321954 DOI: 10.1016/j.clbc.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/20/2023] [Accepted: 05/21/2023] [Indexed: 06/17/2023]
Abstract
INTRODUCTION This study evaluated the performance of primary foci of breast cancer on multiparametric magnetic resonance imaging (MRI) contributing to establish and validate radiomics-based nomograms for predicting the different pathological outcome of breast cancer patients after neoadjuvant chemotherapy (NAC). MATERIALS AND METHODS Retrospectively collected 387 patients with locally advanced breast cancer, all treated with NAC and received breast dynamic contrast-enhanced MRI (DCE-MRI) before NAC. Radiomics signatures were extracted from region of interest (ROI) on multiparametric MRI to build rad score. Clinical-pathologic data and radiological features established the clinical model. The comprehensive model featured rad-score, predictive clinical-pathologic data and radiological features, which was ultimately displayed as a nomogram. Patients were grouped in 2 different ways in accordance with the Miller-Payne (MP) grading of surgical specimens. The first grouping method: 181 patients with pathological reaction grades Ⅳ∼Ⅴ were included in the significant remission group, while 206 patients with pathological reaction grades Ⅰ∼Ⅲ were included in the nonsignificant remission group. The second grouping method: 117 patients with pathological complete response (pCR) were assigned to the pCR group, and 270 patients who failed to meet pCR were assigned to in the non-pCR group. Two combined nomograms are created from 2 grouped data for predicting different pathological responses to NAC. The area under the curves (AUC) of the receiver operating characteristic curves (ROC) were used to evaluate the performance of each model. While decision curve analysis (DCA) and calibration curves were used for estimating the clinical application value of the nomogram. RESULTS Two combined nomograms embodying rad score and clinical-pathologic data outperformed, showing good calibrations for predicting response to NAC. The combined nomogram predicting pCR showed the best performance with the AUC values of 0.97, 0.90 and 0.86 in the training, testing, and external validation cohorts respectively. The AUC values of another combined nomogram predicting significant remission: 0.98, 0.88 0.80 in the training, testing and external validation cohorts. DCA showed the comprehensive model nomogram obtained the most clinical benefit. CONCLUSIONS The combined nomogram could preoperatively predict significant remission or even pCR to NAC in breast cancer based on multiparametric MRI and clinical-pathologic data.
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Affiliation(s)
- Xiaolin Wang
- Department of Breast Imaging, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hui Hua
- Department of Thyroid Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Junqi Han
- Department of Breast Imaging, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xin Zhong
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jingjing Liu
- Department of Breast Imaging, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jingjing Chen
- Department of Breast Imaging, The Affiliated Hospital of Qingdao University, Qingdao, China.
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Albarrán V, Chamorro J, Pozas J, San Román M, Rosero DI, Saavedra C, Gion M, Cortés A, Escalera E, Guerra E, López Miranda E, Fernández Abad M, Martínez Jañez N. Maintained complete response to talazoparib in a BRCA-2 mutated metastatic luminal breast cancer: case report and review of literature. Front Oncol 2023; 13:1158981. [PMID: 37213307 PMCID: PMC10196382 DOI: 10.3389/fonc.2023.1158981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 04/20/2023] [Indexed: 05/23/2023] Open
Abstract
PARP inhibitors are progressively becoming a part of our therapeutic arsenal against BRCA-defective tumors, because of their capacity to induce synthetic lethality in cells with a deficiency in the homologous recombination repair system. Olaparib and talazoparib have been approved for metastatic breast cancer in carriers of germline BRCA mutations, which are found in approximately 6% of patients with breast cancer. We report the case of a patient with metastatic breast cancer, carrier of a germline mutation in BRCA2, with a complete response to first-line treatment with talazoparib, maintained after 6 years. To the best of our knowledge, this is the longest response reported with a PARP inhibitor in a BRCA-mutated tumor. We have made a review of literature, regarding the rationale for PARP inhibitors in carriers of BRCA mutations and their clinical relevance in the management of advanced breast cancer, as well as their emerging role in early stage disease, alone and in combination with other systemic therapies.
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Gu JH, He C, Zhao QY, Jiang TA. Usefulness of new shear wave elastography in early predicting the efficacy of neoadjuvant chemotherapy for patients with breast cancer: where and when to measure is optimal? Breast Cancer 2022; 29:478-486. [PMID: 35038129 DOI: 10.1007/s12282-021-01327-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 12/22/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND The aim of this study was to investigate the diagnosis performance of new shear wave elastography (sound touch elastography, STE) in the prediction of neoadjuvant chemotherapy (NAC) response at an early stage in breast cancer patients and to determine the optimal measurement locations around the lesion in different ranges. METHODS One hundred and eight patients were analyzed in this prospective study from November 2018 to December 2020. All patients completed NAC treatment and underwent STE examination at three time points [the day before NAC (t0); the day before the second course (t1); the day before third course (t2)]. The stiffness of the whole lesion (G), 1-mm shell (S1) and 2-mm shell (S2) around the lesion was expressed by STE parameters. The relative changes (∆stiffness) of STE parameters after the first and second course of NAC were calculated and shown as the variables [Δ(t1) and Δ(t2)]. The diagnostic accuracy of STE was evaluated by means of receiver operating characteristic curve analysis. RESULTS The ∆stiffness (%) including ∆Gmean(t2), ∆S1mean(t2) and ∆S2mean(t2) all showed significant differences between pathological complete response (pCR) and non-pCR groups. ∆S2mean(t2) displayed the best predictive performance for pCR (AUC = 0.842) with an ideal ∆stiffness threshold value - 26%. CONCLUSIONS Measuring the relative changes in the stiffness of surrounding tissue or entire lesion with STE holds promise for effectively predicting the response to NAC at its early stage for breast cancer patients and ∆stiffness of shell 2 mm after the second course of NAC may be a potential prediction parameter.
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Affiliation(s)
- Jiong-Hui Gu
- Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Chang He
- Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Qi-Yu Zhao
- Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Tian-An Jiang
- Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, People's Republic of China.
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Deep learning radiomics of ultrasonography can predict response to neoadjuvant chemotherapy in breast cancer at an early stage of treatment: a prospective study. Eur Radiol 2021; 32:2099-2109. [PMID: 34654965 DOI: 10.1007/s00330-021-08293-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/18/2021] [Accepted: 08/21/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Breast cancer (BC) is the most common cancer in women worldwide, and neoadjuvant chemotherapy (NAC) is considered the standard of treatment for most patients with BC. However, response rates to NAC vary among patients, which leads to delays in appropriate treatment and affects the prognosis for patients who ineffectively respond to NAC. This study aimed to investigate the feasibility of deep learning radiomics (DLR) in the prediction of NAC response at an early stage. METHODS In total, 168 patients with clinicopathologically confirmed BC were enrolled in this prospective study, from March 2016 to December 2020. All patients completed NAC treatment and underwent ultrasonography (US) at three time points (before NAC, after the second course, and after the fourth course). We developed two DLR models, DLR-2 and DLR-4, for predicting responses after the second and fourth courses of NAC. Furthermore, a novel deep learning radiomics pipeline (DLRP) was proposed for stepwise prediction of response at different time points of NAC administration. RESULTS In the validation cohort, DLR-2 achieved an AUC of 0.812 (95% CI: 0.770-0.851) with an NPV of 83.3% (95% CI: 76.5-89.6). DLR-4 achieved an AUC of 0.937 (95% CI: 0.913-0.955) with a specificity of 90.5% (95% CI: 86.3-94.2). Moreover, 19 of 21 non-response patients were successfully identified by DLRP, suggesting that they could benefit from treatment strategy adjustment at an early stage of NAC. CONCLUSIONS The proposed DLRP strategy holds promise for effectively predicting NAC response at its early stage for BC patients. KEY POINTS • We proposed two novel deep learning radiomics (DLR) models to predict response to neoadjuvant chemotherapy (NAC) in breast cancer (BC) patients based on US images at different NAC time points. • Combining two DLR models, a deep learning radiomics pipeline (DLRP) was proposed for stepwise prediction of response to NAC. • The DLRP may provide BC patients and physicians with an effective and feasible tool to predict response to NAC at an early stage and to determine further personalized treatment options.
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Patterns of Recurrence after Neoadjuvant Therapy in Early Breast Cancer, according to the Residual Cancer Burden Index and Reductions in Neoadjuvant Treatment Intensity. Cancers (Basel) 2021; 13:cancers13102492. [PMID: 34065332 PMCID: PMC8161089 DOI: 10.3390/cancers13102492] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/10/2021] [Accepted: 05/18/2021] [Indexed: 12/17/2022] Open
Abstract
Simple Summary The residual cancer burden (RCB) score provides prognostic information on the survival of breast cancer patients who underwent neoadjuvant systemic therapy, with the greatest impact of higher scores on worse recurrence-free survival (RFS) and overall survival (OS) in triple-negative and HER2 positive patients. The impact of chemotherapy dose reduction on RCB is currently unknown, and should therefore be critically evaluated by clinicians. Our study confirms the prognostic relevance of the RCB score and suggests a potential association of the RCB with dose reduction having adverse impact on the RCB, thereby potentially impacting the prognosis of patients, as shown here in a large breast cancer cohort at the Medical University of Graz. Abstract Background: The prognostic performance of the residual cancer burden (RCB) score is a promising tool for breast cancer patients undergoing neoadjuvant therapy. We independently evaluated the prognostic value of RCB scores in an extended validation cohort. Additionally, we analyzed the association between chemotherapy dose reduction and RCB scores. Methods: In this extended validation study, 367 breast cancer patients with available RCB scores were followed up for recurrence-free survival (RFS), distant disease-free survival (DDFS), and overall survival (OS). We also computed standardized cumulative doses of anthracyclines and taxanes (A/Ts) to investigate a potential interaction between neoadjuvant chemotherapy dose reduction and RCB scores. Results: Higher RCB scores were consistently associated with adverse clinical outcomes across different molecular subtypes (HR for RFS = 1.60, 95% CI 1.33–1.93, p < 0.0001; HR for DDFS = 1.70, 95% CI 1.39–2.05, p < 0.0001; HR for OS = 1.67, 95% CI 1.34–2.08, p < 0.0001). The adverse impact prevailed throughout 5 years of follow-up, with a peak for relapse risk between 1–2 years after surgery. Clinical outcomes of patients with RCB class 1 did not differ substantially at 5 years compared to RCB class 0. A total of 180 patients (49.1%) underwent dose reduction of neoadjuvant A/T chemotherapy. We observed a statistically significant interaction between dose reduction and higher RCB scores (interaction p-value = 0.042). Conclusion: Our results confirm RCB score as a prognostic marker for RFS, DDFS, and OS independent of the molecular subtype. Importantly, we show that lower doses of cumulative neoadjuvant A/T were associated with higher RCB scores in patients who required a dose reduction.
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Sejben A, Kószó R, Kahán Z, Cserni G, Zombori T. Examination of Tumor Regression Grading Systems in Breast Cancer Patients Who Received Neoadjuvant Therapy. Pathol Oncol Res 2020; 26:2747-2754. [PMID: 32691390 PMCID: PMC7471177 DOI: 10.1007/s12253-020-00867-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/29/2020] [Indexed: 12/16/2022]
Abstract
Neoadjuvant therapy is a common form of treatment in locally advanced breast cancer (LABC) patients. Besides some guidelines for grading regression, a standardized general scheme is not yet available. The aim of our study was to compare the prognostic impact of different regression grading systems, namely the TR/NR, Chevallier, Sataloff, Denkert-Sinn, Miller-Payne, NSABP-B18, Residual Disease in Breast and Nodes and Residual Cancer Burden (RCB) on disease-free (DFS) and overall survival (OS). Data of 746 breast cancer patients treated in neoadjuvant setting between 1999 and 2019 have been included. The different regression grades and follow-up data were collected from medical charts. Statistical analysis included the Kaplan-Meier method, log-rank test and multivariate Cox regression. The average patient age was 55 years. The DFS and OS estimates of patients with complete pathological regression and residual in situ carcinoma have been significantly more favorable than those having partial regression or no signs of regression (pDFS<0.001, pOS < 0.001). Significant differences were found between DFS estimates of classes with partial regression and without regression defined by RCB. Concerning DFS estimates, the RCB classification (p = 0.019), while regarding OS data the y-stage (p = 0.011) and the nodal status (ypN; p = 0.045) were significant prognosticators by multivariate Cox regression. Regression grading systems help the evaluation of regression in LABC patients treated with neoadjuvant therapy. Of the several grading systems compared, the RCB classification makes the best distinction between the outcomes of the different classes, therefore we recommend the inclusion of RCB into the histopathological findings.
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Affiliation(s)
- Anita Sejben
- Department of Pathology, Faculty of Medicine, University of Szeged, Állomás u. 1., Szeged, 6725, Hungary.
| | - Renáta Kószó
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Zsuzsanna Kahán
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Gábor Cserni
- Department of Pathology, Faculty of Medicine, University of Szeged, Állomás u. 1., Szeged, 6725, Hungary
- Department of Pathology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
| | - Tamás Zombori
- Department of Pathology, Faculty of Medicine, University of Szeged, Állomás u. 1., Szeged, 6725, Hungary
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Hamy AS, Darrigues L, Laas E, De Croze D, Topciu L, Lam GT, Evrevin C, Rozette S, Laot L, Lerebours F, Pierga JY, Osdoit M, Faron M, Feron JG, Laé M, Reyal F. Prognostic value of the Residual Cancer Burden index according to breast cancer subtype: Validation on a cohort of BC patients treated by neoadjuvant chemotherapy. PLoS One 2020; 15:e0234191. [PMID: 32579551 PMCID: PMC7313974 DOI: 10.1371/journal.pone.0234191] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 05/20/2020] [Indexed: 12/21/2022] Open
Abstract
Introduction The Residual Cancer Burden (RCB) quantifies residual disease after neoadjuvant chemotherapy (NAC). Its predictive value has not been validated on large cohorts with long-term follow up. The objective of this work is to independently evaluate the prognostic value of the RCB index depending on BC subtypes (Luminal, HER2-positive and triple negative (TNBCs)). Methods We retrospectively evaluated the RCB index on surgical specimens from a cohort of T1-T3NxM0 BC patients treated with NAC between 2002 and 2012. We analyzed the association between RCB index and relapse-free survival (RFS), overall survival (OS) among the global population, after stratification by BC subtypes. Results 717 patients were included (luminal BC (n = 222, 31%), TNBC (n = 319, 44.5%), HER2-positive (n = 176, 24.5%)). After a median follow-up of 99.9 months, RCB index was significantly associated with RFS. The RCB-0 patients displayed similar prognosis when compared to the RCB-I group, while patients from the RCB-II and RCB-III classes were at increased risk of relapse (RCB-II versus RCB-0: HR = 3.25 CI [2.1–5.1] p<0.001; RCB-III versus RCB-0: HR = 5.6 CI [3.5–8.9] p<0.001). The prognostic impact of RCB index was significant for TNBC and HER2-positive cancers; but not for luminal cancers (Pinteraction = 0.07). The prognosis of RCB-III patients was poor (8-years RFS: 52.7%, 95% CI [44.8–62.0]) particularly in the TNBC subgroup, where the median RFS was 12.7 months. Conclusion RCB index is a reliable prognostic score. RCB accurately identifies patients at a high risk of recurrence (RCB-III) with TNBC or HER2-positive BC who must be offered second-line adjuvant therapies.
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Affiliation(s)
- Anne-Sophie Hamy
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, INSERM, U932 Immunity and Cancer, Institut Curie, Paris, France
- Department of Medical Oncology, Institut Curie, Saint-Cloud, France
| | - Lauren Darrigues
- Department of Surgery, Faculté de Médecine Descartes, Université Paris, Institut Curie, Paris, France
| | - Enora Laas
- Department of Surgery, Faculté de Médecine Descartes, Université Paris, Institut Curie, Paris, France
| | - Diane De Croze
- Department of Tumor Biology, Institut Curie, Saint-Cloud, France
| | - Lucian Topciu
- Department of Tumor Biology, Institut Curie, Paris, France
| | - Giang-Thanh Lam
- Department of Surgery, Faculté de Médecine Descartes, Université Paris, Institut Curie, Paris, France
- Department of Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - Clemence Evrevin
- Department of Medical Oncology, Institut Curie, Saint-Cloud, France
| | - Sonia Rozette
- Department of Medical Oncology, Institut Curie, Saint-Cloud, France
| | - Lucie Laot
- Department of Surgery, Faculté de Médecine Descartes, Université Paris, Institut Curie, Paris, France
| | | | - Jean-Yves Pierga
- Department of Medical Oncology, Institut Curie, Saint-Cloud, France
- Department of Surgery, Faculté de Médecine Descartes, Université Paris, Institut Curie, Paris, France
| | - Marie Osdoit
- Department of Surgery, Faculté de Médecine Descartes, Université Paris, Institut Curie, Paris, France
| | - Matthieu Faron
- Department of biostatistics and epidemiology, INSERM 1018 CESP Oncostat team, Gustave Roussy Cancer Campus, Villejuif, France
| | - Jean-Guillaume Feron
- Department of Surgery, Faculté de Médecine Descartes, Université Paris, Institut Curie, Paris, France
| | - Marick Laé
- Department of Tumor Biology, Institut Curie, Paris, France
| | - Fabien Reyal
- Department of Medical Oncology, Institut Curie, Saint-Cloud, France
- Department of Surgery, Faculté de Médecine Descartes, Université Paris, Institut Curie, Paris, France
- * E-mail:
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Bossuyt V, Spring L. Pathologic evaluation of response to neoadjuvant therapy drives treatment changes and improves long-term outcomes for breast cancer patients. Breast J 2020; 26:1189-1198. [PMID: 32468652 DOI: 10.1111/tbj.13864] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 01/03/2020] [Indexed: 11/29/2022]
Abstract
Systemic therapy for breast cancer may be given before (neoadjuvant) or after (adjuvant) surgery. When neoadjuvant systemic therapy is given, response to treatment can be evaluated. However, some prognostic information (for example, pathologic tumor size pretreatment) is then lost and pathologic evaluation of breast specimens after neoadjuvant therapy is more difficult. Pathologic complete response (pCR), defined as no invasive disease in the breast (ypT0/is or ypT0) and no disease in all sampled lymph nodes (ypN0), identifies patients with a lower risk of recurrence or death compared to those with residual disease. Multidisciplinary collaboration, marking of the tumor site and any lymph node involvement pretreatment, and access to specimen imaging to facilitate correlation of gross and microscopic findings are critical for accurate determination of pCR. For HER2-positive and triple negative tumors requiring systemic therapy, giving the treatment before surgery identifies a high-risk group of patients that can receive additional adjuvant therapy after surgery if a pCR is not achieved. Recent clinical trials have demonstrated that this approach reduced recurrence risk. More than ever, pathologic evaluation of response to neoadjuvant systemic therapy directs treatment received after surgery. Using a single standardized protocol for sampling of the post-neoadjuvant surgical specimen allows pathologists to ensure accurate determination of pCR or residual disease and quantify residual disease. Residual cancer burden (RCB) and AJCC stage provide complementary quantitative information about residual disease and prognosis.
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Affiliation(s)
- Veerle Bossuyt
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Laura Spring
- Massachusetts General Hospital, Boston, Massachusetts, USA
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Pathologic chemotherapy response score in epithelial ovarian cancer: Surgical, genetic, and survival considerations. Surg Oncol 2020; 34:40-45. [PMID: 32891351 DOI: 10.1016/j.suronc.2020.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/04/2020] [Accepted: 03/05/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE A pathologic chemotherapy response score (CRS) is used to grade ovarian cancer response to neoadjuvant chemotherapy (NACT). We evaluated the prognostic significance of the CRS in a single institution cohort. METHODS A retrospective review of all consecutive epithelial ovarian cancer patients undergoing interval debulking surgery (IDS) after NACT from 2016 to 2017 were included. Clinical, pathologic, surgical, outcomes, and genetic data were abstracted from medical records. CRS was assigned by pathology based on a section of omentum as follows: 1 = minimal response, 2 = moderate response, and 3 = near complete response. RESULTS Among the 50 subjects, 14 (28%) were classified as CRS1, 29 (58%) as CRS2, and 7 (14%) as CRS3. The majority of patients were diagnosed with high grade serous histology (94%). Most women in this cohort underwent either an optimal or complete cytoreduction to no gross residual disease (96%). Women in the CRS2 group were most likely to have a pathogenic variant (51.7%) while those in the CRS1 were least likely (7.1%). Most women recurred regardless of CRS. CRS was not associated with progression-free survival (log-rank p = 0.82) or overall survival (log-rank p = 0.30). CONCLUSIONS Though previous data support the use of CRS as a prognostic indicator, we failed to show a correlation between CRS and survival in our continuous single institution cohort. The high rate of optimal debulking across all CRS groups in this study may mitigate the prognostic significance of the scoring system. Nevertheless, tumors that respond poorly to traditional chemotherapy should remain of avid interest for potential novel therapies.
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12
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Wu J, Kong R, Tian S, Li H, Wu K, Kong L. Can trastuzumab emtansine be replaced by additional chemotherapy plus targeted therapy for HER2-overexpressing breast cancer patients with residual disease after neoadjuvant chemotherapy? Chin J Cancer Res 2020; 31:878-891. [PMID: 31949390 PMCID: PMC6955160 DOI: 10.21147/j.issn.1000-9604.2019.06.04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Human epidermal growth factor receptor 2 (HER2)-overexpressing breast cancer is an aggressive phenotype with a poor prognosis, and can easily metastasize and recur. Currently, chemotherapy plus HER2-targeted therapy is the standard systemic treatment for most of these patients. Given that neoadjuvant chemotherapy (NAC) has an efficacy equivalent to that of adjuvant chemotherapy and some additional benefits, many patients, especially those with more advanced tumors, prefer NAC and generally will not receive additional chemotherapy after surgery, irrespective of the pathological response. However, achieving pathological complete response to NAC is strongly correlated with prognosis, especially in triple-negative and HER2-overexpressing breast cancer. Therefore, postoperative treatment of these patients with residual diseases should be optimized to achieve favorable outcomes. The CREATE-X study has confirmed that additional chemotherapy can improve the outcomes of patients with HER2-negative residual disease after NAC. In addition, chemotherapy plays an indispensable role in the treatment of patients who receive surgery directly or who have recurrent lesions. Therefore, can additional chemotherapy improve prognosis of patients with HER2-overexpressing residual breast cancer? At present, no studies have compared the efficacy of additional chemotherapy plus trastuzumab with that of anti-HER2 therapy alone in residual cancer. The KATHERINE study revealed that trastuzumab emtansine (T-DM1) can reduce the risk of recurrence or death by 50% compared with trastuzumab in patients with HER2-positive residual invasive breast cancer after neoadjuvant therapy. T-DM1 is an antibody-drug conjugate of trastuzumab and the cytotoxic agent emtansine, and thus, to an extent, T-DM1 is equivalent to simultaneous application of chemotherapy and targeted therapy. However, high cost and low accessibility limit its use especially in low- and middle-income countries and regions. Hence, we proposed this perspective that additional chemotherapy plus trastuzumab should be given to HER2-overexpressing breast cancer patients with residual disease after NAC to improve their prognosis by discussing that the efficacy of additional chemotherapy plus trastuzumab is superior to that of anti-HER2 therapy alone and not inferior to T-DM1. Additional chemotherapy plus trastuzumab-based HER2-targeted therapy can be used as an alternative regimen to T-DM1 when T-DM1 is unavailable. However, further clinical research on the selection of chemotherapeutic agents is warranted.
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Affiliation(s)
- Juan Wu
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Rong Kong
- Department of Physics, Applied Optics Beijing Area Major Laboratory, Beijing Normal University, Beijing 100875, China
| | - Shen Tian
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Hao Li
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Kainan Wu
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Lingquan Kong
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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13
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Senn N, Masannat Y, Husain E, Siow B, Heys SD, He J. q-Space Imaging Yields a Higher Effect Gradient to Assess Cellularity than Conventional Diffusion-weighted Imaging Methods at 3.0 T: A Pilot Study with Freshly Excised Whole-Breast Tumors. Radiol Imaging Cancer 2019; 1:e190008. [PMID: 33778671 PMCID: PMC7983771 DOI: 10.1148/rycan.2019190008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/16/2019] [Accepted: 07/25/2019] [Indexed: 11/29/2022]
Abstract
Purpose To determine whether q-space imaging (QSI), an advanced diffusion-weighted MRI method, provides a higher effect gradient to assess tumor cellularity than existing diffusion imaging methods, and fidelity to cellularity obtained from histologic analysis. Materials and Methods In this prospective study, diffusion-weighted images were acquired from 20 whole-breast tumors freshly excised from participants (age range, 35-78 years) by using a clinical 3.0-T MRI unit. Median and skewness values were extracted from the histogram distributions obtained from QSI, monoexponential model, diffusion kurtosis imaging (DKI), and stretched exponential model (SEM). The skewness from QSI and other diffusion models was compared by using paired t tests and relative effect gradient obtained from correlating skewness values. Results The skewness obtained from QSI (mean, 1.34 ± 0.77 [standard deviation]) was significantly higher than the skewness from monoexponential fitting approach (mean, 1.09 ± 0.67; P = .015), SEM (mean, 1.07 ± 0.70; P = .014), and DKI (mean, 0.97 ± 0.63; P = .004). QSI yielded a higher effect gradient in skewness (percentage increase) compared with monoexponential fitting approach (0.26 of 0.74; 35.1%), SEM (0.26 of 0.74; 35.1%), and DKI (0.37 of 0.63; 58.7%). The skewness and median from QSI were significantly correlated with the skewness (ρ = -0.468; P = .038) and median (ρ = -0.513; P = .021) of cellularity from histologic analysis. Conclusion QSI yields a higher effect gradient in assessing breast tumor cellularity than existing diffusion methods, and fidelity to underlying histologic structure.Keywords: Breast, MR-Diffusion Weighted Imaging, MR-Imaging, Pathology, Tissue Characterization, Tumor ResponseOnline supplemental material is available for this article.Published under a CC BY 4.0 license.
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Affiliation(s)
| | | | - Ehab Husain
- From the Institute of Medical Sciences, School of Medicine, University of Aberdeen, Aberdeen AB25 2ZD, Scotland (N.S., S.D.H., J.H.); Breast Unit (Y.M., S.D.H.) and Department of Pathology (E.H.), Aberdeen Royal Infirmary, Aberdeen, Scotland; and MRI Unit, The Francis Crick Institute, London, England (B.S.)
| | - Bernard Siow
- From the Institute of Medical Sciences, School of Medicine, University of Aberdeen, Aberdeen AB25 2ZD, Scotland (N.S., S.D.H., J.H.); Breast Unit (Y.M., S.D.H.) and Department of Pathology (E.H.), Aberdeen Royal Infirmary, Aberdeen, Scotland; and MRI Unit, The Francis Crick Institute, London, England (B.S.)
| | - Steven D. Heys
- From the Institute of Medical Sciences, School of Medicine, University of Aberdeen, Aberdeen AB25 2ZD, Scotland (N.S., S.D.H., J.H.); Breast Unit (Y.M., S.D.H.) and Department of Pathology (E.H.), Aberdeen Royal Infirmary, Aberdeen, Scotland; and MRI Unit, The Francis Crick Institute, London, England (B.S.)
| | - Jiabao He
- From the Institute of Medical Sciences, School of Medicine, University of Aberdeen, Aberdeen AB25 2ZD, Scotland (N.S., S.D.H., J.H.); Breast Unit (Y.M., S.D.H.) and Department of Pathology (E.H.), Aberdeen Royal Infirmary, Aberdeen, Scotland; and MRI Unit, The Francis Crick Institute, London, England (B.S.)
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14
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Müller HD, Posch F, Suppan C, Bargfrieder U, Gumpoldsberger M, Hammer R, Hauser H, Dandachi N, Prein K, Stoeger H, Lax S, Balic M. Validation of Residual Cancer Burden as Prognostic Factor for Breast Cancer Patients After Neoadjuvant Therapy. Ann Surg Oncol 2019; 26:4274-4283. [PMID: 31452052 PMCID: PMC6864028 DOI: 10.1245/s10434-019-07741-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Indexed: 12/31/2022]
Abstract
Background Assessing the residual cancer burden (RCB) predictive performance, the potential subgroup effects, and time-dependent impact on breast cancer patients who underwent neoadjuvant therapy in a developer’s independent cohort is essential for its usage in clinical routine. Methods Between 2011 and 2016, the RCB scores of 184 female breast cancer patients were prospectively collected, and subsequent clinicopathological and follow-up data were obtained retrospectively. Recurrence-free survival (RFS), overall survival (OS), as well as subgroup analysis, and time-dependent variables were calculated with multivariate, complex, or linear statistical models. Results A total of 184 patients (HER2 33%, TNBC 27%), with a mean follow-up time of 4 years, treated with neoadjuvant systemic therapy (92% anthracycline-taxane based) were analyzed revealing 43 events (38 recurrences, 28 deaths). High RCB scores were associated with recurrence (median index: 2.34 vs. 1.39 points, rank-sum p < 0.0001), decreased RFS (hazard ratio [HR] = 1.80, 95% confidence interval [CI] 1.44–2.24, p < 0.0001) and reduced OS (HR 1.96, 95% CI 1.49–2.59, p < 0.0001). The RCB score showed proportionality of hazards (interaction HR with linear follow-up time = 1.00, p = 0.896) and good discriminating power (Harrell’s c index 0.7). Conclusions Our results confirm the RCB score as externally valid prognostic marker and being independent of molecular subtype for RFS and OS in a clinical setting. Electronic supplementary material The online version of this article (10.1245/s10434-019-07741-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hannah Deborah Müller
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,Comprehensive Cancer Center Graz, Medical University of Graz, Graz, Austria
| | - Florian Posch
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,Comprehensive Cancer Center Graz, Medical University of Graz, Graz, Austria
| | - Christoph Suppan
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,Comprehensive Cancer Center Graz, Medical University of Graz, Graz, Austria
| | - Ute Bargfrieder
- Department of Pathology, Hospital Graz South-West, Graz, Austria
| | - Melanie Gumpoldsberger
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,Comprehensive Cancer Center Graz, Medical University of Graz, Graz, Austria
| | - Robert Hammer
- Department of Surgery, Hospital Graz South-West, Graz, Austria
| | - Hubert Hauser
- Department of Surgery, Hospital Graz South-West, Graz, Austria
| | - Nadia Dandachi
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,Comprehensive Cancer Center Graz, Medical University of Graz, Graz, Austria
| | - Kurt Prein
- Department of Pathology, Hospital Graz South-West, Graz, Austria
| | - Herbert Stoeger
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,Comprehensive Cancer Center Graz, Medical University of Graz, Graz, Austria
| | - Sigurd Lax
- Department of Pathology, Hospital Graz South-West, Graz, Austria.,Institute of Pathology, Medical University of Graz, Graz, Austria.,Department of Pathology, Johannes Keppler Univeristy Linz, Linz, Austria
| | - Marija Balic
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria. .,Comprehensive Cancer Center Graz, Medical University of Graz, Graz, Austria.
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15
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Sholl LM. Understanding patterns of pathologic response following neoadjuvant immunotherapy for solid tumors. Ann Oncol 2019; 29:1630-1632. [PMID: 30052725 DOI: 10.1093/annonc/mdy227] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- L M Sholl
- Department of Pathology, Brigham and Women's Hospital, Boston, USA.
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16
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Baker GM, King TA, Schnitt SJ. Evaluation of Breast and Axillary Lymph Node Specimens in Breast Cancer Patients Treated With Neoadjuvant Systemic Therapy. Adv Anat Pathol 2019; 26:221-234. [PMID: 31149907 DOI: 10.1097/pap.0000000000000237] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Breast and axillary lymph node specimens from breast cancer patients treated with neoadjuvant systemic therapy are being encountered by pathologists with increasing frequency. Evaluation of these specimens presents challenges that differ from those encountered during the examination of other types of breast specimens. This article reviews the key issues regarding the gross and microscopic evaluation of post-neoadjuvant systemic therapy breast and lymph node specimens, and emphasizes the importance of accurate specimen evaluation in assessing treatment response.
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17
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Comparison of Pathologic Response Evaluation Systems After Neoadjuvant Chemotherapy in Breast Cancers: Correlation With Computer-Aided Diagnosis of MRI Features. AJR Am J Roentgenol 2019; 213:944-952. [PMID: 31237439 DOI: 10.2214/ajr.18.21016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE. The objective of our study was to compare pathologic response assessment systems with dynamic contrast-enhanced MRI (DCE-MRI) features and evaluate the predictive performance of DCE-MRI features relative to different pathologic response assessment systems after neoadjuvant chemotherapy (NAC). MATERIALS AND METHODS. This retrospective study included 223 women (mean age, 47.2 years; age range, 31-71 years) who underwent DCE-MRI before and after completing NAC before definitive surgery between January and December 2015. Six MRI features (i.e., tumor size; angio volume; peak enhancement; and persistent, plateau, and washout enhancing components) were measured and correlated with the Miller-Payne grading system, residual cancer burden (RCB) class, and modified in-breast RCB index. Percentage changes in MRI features were correlated with pathologic assessment systems using the Spearman rank correlation test; ROC curves were analyzed to predict pathologic outcomes. RESULTS. All six MRI features correlated most strongly with the in-breast RCB index (r = -0.75 to -0.51, p < 0.001) followed by the Miller-Payne system (r = 0.47-0.72, p < 0.001) and RCB class (r = -0.58 to -0.41, p < 0.001). The in-breast RCB index correlated most strongly with the angio volume reduction rate (r = -0.75, p < 0.001) followed by maximum diameter (r = -0.69, p < 0.001), peak enhancement (r = -0.67, p < 0.001), washout component (r = -0.60, p < 0.001), plateau component (r = -0.59, p < 0.001), and persistent component (r = -0.51, p < 0.001). CONCLUSION. The in-breast RCB index correlated best with changes in DCE-MRI features, and the MRI-measured angio volume reduction rate correlated best with pathologic tumor responses.
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18
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Zaheed M, Wilcken N, Willson ML, O'Connell DL, Goodwin A. Sequencing of anthracyclines and taxanes in neoadjuvant and adjuvant therapy for early breast cancer. Cochrane Database Syst Rev 2019; 2:CD012873. [PMID: 30776132 PMCID: PMC6378927 DOI: 10.1002/14651858.cd012873.pub2] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Anthracyclines and taxanes are chemotherapeutic agents widely used in a sequential regimen in the adjuvant and neoadjuvant treatment of early breast cancer to reduce the risk of cancer recurrence. Standard practice is to administer anthracycline-based chemotherapy followed by a taxane. Anthracyclines tend to be administered first as they were established before taxanes for treatment of early breast cancer. OBJECTIVES To assess whether the sequence in which anthracyclines and taxanes are administered affects outcomes for people with early breast cancer receiving adjuvant or neoadjuvant therapy. SEARCH METHODS We searched Cochrane Breast Cancer's Specialised Register, CENTRAL, MEDLINE, Embase, the World Health Organization's International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov on 1 February 2018. SELECTION CRITERIA Randomised controlled trials comparing administering a taxane prior to an anthracycline with taxane following anthracycline to people with early breast cancer receiving chemotherapy. The studies needed to have reported on at least one of our outcomes of interest, which included overall survival, disease-free survival, pathological response, treatment adherence, toxicity and quality of life. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data, assessed risk of bias and quality of the evidence. The primary outcome measure was overall survival. Secondary outcomes included disease-free survival, pathological response (in the neoadjuvant setting only), adverse events, treatment adherence and quality of life. For time-to-event outcomes of overall survival and disease-free survival, we derived hazard ratios (HRs) with 95% confidence intervals (CI) where possible. For dichotomous outcomes of pathological complete response, treatment adherence and adverse events, we reported the treatment effect as a risk ratio (RR) with 95% CI where possible. We used GRADE to assess the certainty of the evidence separately for the neoadjuvant and adjuvant settings. MAIN RESULTS There were 1415 participants in five neoadjuvant studies and 280 participants in four adjuvant studies involving five treatment comparisons. Four of the five neoadjuvant studies collected data for the primary outcome (overall survival) and two studies had data available; one of the four adjuvant studies collected overall survival data.The neoadjuvant studies suggested that the administration of taxanes first probably resulted in little to no difference in overall survival (HR 0.80, 95% CI 0.60 to 1.08; 947 participants; 2 studies; moderate-certainty evidence) and disease-free survival (HR 0.84, 95% CI 0.65 to 1.09; 828 participants; 1 study; moderate-certainty evidence). Administration of taxanes first also resulted in little to no difference in pathological complete response (absence of cancer in the breast and axilla: RR 1.15, 95% CI 0.96 to 1.38; 1280 participants; 4 studies; high-certainty evidence). However, there appeared to be a trend in favour of taxanes first. Studies reported treatment adherence using a range of measures. Administration of taxanes first probably did not increase the likelihood of requiring dose reductions compared to administration of anthracyclines first (RR 0.81, 95% CI 0.59 to 1.11; 280 participants; 1 study; moderate-certainty evidence). There was probably little to no difference in the risk of grade 3/4 neutropenia (RR 1.25, 95% CI 0.86 to 1.82; 280 participants, 1 study; moderate-certainty evidence) or grade 3/4 neurotoxicity (RR 0.95, 95% CI 0.55 to 1.65; 1108 participants; 2 studies; low-certainty evidence) when taxanes were given first. There were no data on quality of life.Only one adjuvant study collected data on overall survival and disease-free survival but did not report data. Administration of taxanes first reduced the risk of grade 3/4 neutropenia (RR 0.62, 95% CI 0.40 to 0.97; 279 participants; 4 studies, 5 treatment comparisons; high-certainty evidence) and appeared to result in little to no difference in grade 3/4 neurotoxicity (RR 0.78, 95% CI 0.25 to 2.46; 162 participants; 3 studies; low-certainty evidence). There was probably little to no difference in the proportions experiencing dose delays when taxanes are given first compared to anthracyclines given first (RR 0.76, 95% CI 0.52 to 1.12; 238 participants; 3 studies, 4 treatment comparisons; moderate-certainty evidence). One study reported on quality of life and indicated that scores (using the Functional Assessment of Cancer Therapy - Breast Cancer (FACT-B) validated questionnaire) were similar in both groups though did not provide numerical data. AUTHORS' CONCLUSIONS In the neoadjuvant setting, there is high- to low-certainty evidence of equivalent outcomes for the sequence in which taxanes are delivered. In the adjuvant setting, none of the studies reported on overall survival or disease-free survival. In most institutions, standard practice would be to deliver anthracycline followed by taxane, and currently available data do not support a change in this practice. We wait for the full-text publication of a relevant neoadjuvant study for women with HER2-negative breast cancer for inclusion in an update of this review.
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Affiliation(s)
- Milita Zaheed
- Concord Repatriation General HospitalMedical Oncology DepartmentConcordNew South WalesAustralia2139
| | - Nicholas Wilcken
- Crown Princess Mary Cancer CentreMedical OncologyWestmeadNSWAustralia2145
- The University of SydneySydney Medical SchoolSydneyAustralia
| | - Melina L Willson
- NHMRC Clinical Trials Centre, The University of SydneySystematic Reviews and Health Technology AssessmentsLocked Bag 77SydneyNSWAustralia1450
| | - Dianne L O'Connell
- Cancer Council NSWCancer Research DivisionPO Box 572Kings CrossSydneyNSWAustralia1340
| | - Annabel Goodwin
- Concord Repatriation General HospitalMedical Oncology DepartmentConcordNew South WalesAustralia2139
- The University of Sydney, Concord Repatriation General HospitalConcord Clinical SchoolConcordNSWAustralia2137
- Sydney Local Health District and South Western Sydney Local Health DistrictCancer Genetics DepartmentSydneyAustralia
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19
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Mrkonjic M, Berman HK, Done SJ, Youngson B, Mulligan AM. Breast specimen handling and reporting in the post-neoadjuvant setting: challenges and advances. J Clin Pathol 2019; 72:120-132. [PMID: 30670564 DOI: 10.1136/jclinpath-2018-205598] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 12/23/2022]
Abstract
Neoadjuvant systemic therapy is becoming more commonly used in patients with earlier stages of breast cancer. To assess tumour response to neoadjuvant chemotherapy, pathological evaluation is the gold standard. Depending on the treatment response, the pathological examination of these specimens can be quite challenging. However, a uniform approach to evaluate post-neoadjuvant-treated breast specimens has been lacking. Furthermore, there is no single universally accepted or endorsed classification system for assessing treatment response in this setting. Recent initiatives have attempted to create a standardised protocol for evaluation of post-neoadjuvant breast specimens. This review outlines the necessary information that should be collected prior to macroscopic examination of these specimens, the recommended and most pragmatic approach to tissue sampling for microscopic examination, describes the macroscopic and microscopic features of post-therapy breast specimens, summarises two commonly used systems for classifying treatment response and outlines the critical variables that should be included in the final pathology report.
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Affiliation(s)
- Miralem Mrkonjic
- Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Hal K Berman
- Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Susan J Done
- Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Bruce Youngson
- Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Anna Marie Mulligan
- Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada .,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
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20
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Stebbing J, Baranau Y, Manikhas A, Lee SJ, Thiruchelvam P, Leff D, Esteva FJ. Total pathological complete response versus breast pathological complete response in clinical trials of reference and biosimilar trastuzumab in the neoadjuvant treatment of breast cancer. Expert Rev Anticancer Ther 2018; 18:531-541. [PMID: 29580109 DOI: 10.1080/14737140.2018.1457442] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Trastuzumab is a key drug in the neoadjuvant treatment of breast cancers that overexpress the human epidermal growth factor receptor 2 (HER2). Pathological complete response (pCR) is commonly used as an endpoint in neoadjuvant clinical trials of trastuzumab as evidence suggests it may be a surrogate for long-term survival. Several biosimilar candidates of originator or 'reference' trastuzumab are in development and have used pCR as a primary endpoint to assess therapeutic equivalence between treatments. The exact definition of pCR has varied across studies. Areas covered: Here we look at the clinical relevance of pCR and compare rates of total pCR (defined as ypT0/is ypN0) and breast pCR (defined as ypT0/is) in clinical trials of reference and biosimilar trastuzumab. Expert commentary: In order to evaluate the efficacy of neoadjuvant systemic therapies in a uniform way, standardization of trial endpoints is necessary. Future studies in HER2-positive breast cancer should include full assessment of the breast and lymph node basin before and after neoadjuvant systemic therapy, and the use of total pCR as the primary outcome.
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Affiliation(s)
- Justin Stebbing
- a Division of Surgery and Cancer , Imperial College, Imperial College Healthcare NHS Trust , London , UK
| | - Yauheni Baranau
- b Chemotherapy Department #1 , Minsk City Clinical Oncological Dispensary , Minsk , Belarus
| | - Alexey Manikhas
- c Breast Cancer Department , City Clinical Oncology Dispensary , Saint Petersburg , Russian Federation
| | - Sang Joon Lee
- d Clinical Development Division , CELLTRION Inc , Incheon , Republic of Korea
| | - Paul Thiruchelvam
- a Division of Surgery and Cancer , Imperial College, Imperial College Healthcare NHS Trust , London , UK
| | - Daniel Leff
- a Division of Surgery and Cancer , Imperial College, Imperial College Healthcare NHS Trust , London , UK
| | - Francisco J Esteva
- e Perlmutter Cancer Center , New York University Langone Health , New York , NY , USA
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21
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Clark BZ, Farrugia DJ, Landmann A, Diego EJ, Dabbs DJ, Puhalla SL, Jankowitz RC, Brufsky AM, Ahrendt GM, McAuliffe PF, Bhargava R. Prognostic Significance of Modified Residual Disease in Breast and Nodes (mRDBN) Algorithm After Neoadjuvant Chemotherapy for Breast Cancer. Am J Clin Pathol 2018; 149:332-343. [PMID: 29481634 DOI: 10.1093/ajcp/aqx168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES We hypothesized that prognostic accuracy of the residual disease in breast and lymph nodes (RDBN) method, which is calculated using residual tumor size, nodal involvement, and tumor grade, may be improved by incorporating residual tumor cellularity. METHODS Cases included 614 patients who underwent neoadjuvant therapy for breast cancer. Tumor size was adjusted for residual cellularity of invasive carcinoma and used to calculate modified RDBN (mRDBN) and compared with unmodified gross tumor size (gRDBN). RESULTS RDBN could be calculated in 428 cases. Relative risks of recurrence and death were significantly higher for RDBN-3 and RDBN-4 compared with RDBN-1. Kaplan-Meier analysis showed significant differences in disease-free survival and overall survival for estrogen receptor (ER)-negative/human epidermal growth factor receptor 2 (HER2)-negative and ER-positive/HER2-negative subgroups (P < .0001). CONCLUSIONS Both mRDBN and gRDBN provide prognostic information, particularly in HER2-negative carcinoma; however, mRDBN showed better stratification of RDBN-3 and RDBN-4 patients.
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Affiliation(s)
- Beth Z Clark
- Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Daniel J Farrugia
- Department of Surgery, Division of Surgical Oncology, University of Pittsburgh, Pittsburgh, PA
- Centegra Comprehensive Breast Program, Centegra Health System, Crystal Lake, IL
| | - Alessandra Landmann
- Department of Surgery, Division of Surgical Oncology, University of Pittsburgh, Pittsburgh, PA
- College of Medicine, Department of Surgery, University of Oklahoma, Oklahoma City
| | - Emilia J Diego
- Department of Surgery, Division of Surgical Oncology, University of Pittsburgh, Pittsburgh, PA
| | - David J Dabbs
- Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Shannon L Puhalla
- Department of Medicine, University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - Rachel C Jankowitz
- Department of Medicine, University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - Adam M Brufsky
- Department of Medicine, University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - Gretchen M Ahrendt
- Department of Surgery, Division of Surgical Oncology, University of Pittsburgh, Pittsburgh, PA
- Department of Surgery, University of Colorado, Aurora
| | - Priscilla F McAuliffe
- Department of Surgery, Division of Surgical Oncology, University of Pittsburgh, Pittsburgh, PA
| | - Rohit Bhargava
- Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA
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22
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Abstract
Standardization of quantification of residual disease in the breast and lymph nodes with routine pathologic macroscopic and microscopic evaluation leads to accurate and reproducible measures of response to neoadjuvant treatment. Multidisciplinary collaboration and correlation of clinical, imaging, gross and microscopic findings is essential. The processing approach to post-neoadjuvant breast cancer surgical specimens and the elements needed in the pathology report are the same regardless of breast cancer subtype or type of neoadjuvant treatment. The residual cancer burden incorporates response in the breast and in the lymph nodes into a score that can be combined with other emerging prognostic factors.
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Affiliation(s)
- Veerle Bossuyt
- Department of Pathology, Yale University, PO Box 208023, 310 Cedar Street, New Haven, CT 06520-8023, USA.
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23
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Burgués O, López-García MÁ, Pérez-Míes B, Santiago P, Vieites B, García JF, Peg V. The ever-evolving role of pathologists in the management of breast cancer with neoadjuvant treatment: recommendations based on the Spanish clinical experience. Clin Transl Oncol 2017; 20:382-391. [PMID: 28795336 DOI: 10.1007/s12094-017-1725-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 07/25/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE To compare the current international standards for neoadjuvant systemic therapy (NAST) protocols, and establish consensus recommendations by Spanish breast pathologists; and to look into the Spanish reality of defining pathological complete response in daily practice. MATERIALS AND METHODS A modified Delphi technique was used to gain consensus among a panel of 46 experts with regard to important issues about NAST specimens, with the objective of standardize handling and analysis of these breast cancer specimens. In addition, a survey was conducted among 174 pathologists to explore the Spanish reality of post-NAST breast cancer specimens handling. RESULTS Our survey shows that pathologists in Spain follow the same guidelines as their international colleagues and face the same problems and controversies. Among the experts, 94.1% agreed on the recommendation for a pre-treatment evaluation with a core needle biopsy, and 100% of experts agreed on the need of having properly indicated information for the post-NAST surgical specimens. However, only 82.7% of them receive properly labelled specimens and even less receive specimens where markers are identified and the degree of clinical/radiological response is mentioned. Among participants 59.9% were familiar with the residual cancer burden system for post-NAST response quantification, but only 16.1% used it regularly. CONCLUSIONS Active participation on breast cancer multidisciplinary teams, optimal usage of core needle biopsy for timely and standardized procedures for the diagnostic analysis, and accurate diagnosis of pathological complete response and complete evaluation of the response to NAST need to become the standard practice when handling breast cancer specimens in Spain.
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Affiliation(s)
- O Burgués
- Servicio de Anatomía Patológica, Hospital Clínico Universitario, Avda. Blasco Ibáñez, 17, 46010, Valencia, Spain.
| | - Mª Á López-García
- Servicio de Anatomía Patológica, Hospital Virgen Del Rocío, Seville, Spain
| | - B Pérez-Míes
- Servicio de Anatomía Patológica, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - P Santiago
- Servicio de Anatomía Patológica, Complejo Hospitalario A Coruña, A Coruña, Spain
| | - B Vieites
- Servicio de Anatomía Patológica, Hospital Virgen Del Rocío, Seville, Spain
| | | | - V Peg
- Servicio de Anatomía Patológica, Hospital Vall d'Hebron, Barcelona, Spain
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24
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Symmans WF, Wei C, Gould R, Yu X, Zhang Y, Liu M, Walls A, Bousamra A, Ramineni M, Sinn B, Hunt K, Buchholz TA, Valero V, Buzdar AU, Yang W, Brewster AM, Moulder S, Pusztai L, Hatzis C, Hortobagyi GN. Long-Term Prognostic Risk After Neoadjuvant Chemotherapy Associated With Residual Cancer Burden and Breast Cancer Subtype. J Clin Oncol 2017; 35:1049-1060. [PMID: 28135148 DOI: 10.1200/jco.2015.63.1010] [Citation(s) in RCA: 439] [Impact Index Per Article: 62.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose To determine the long-term prognosis in each phenotypic subset of breast cancer related to residual cancer burden (RCB) after neoadjuvant chemotherapy alone, or with concurrent human epidermal growth factor receptor 2 (HER2)-targeted treatment. Methods We conducted a pathologic review to measure the continuous RCB index (wherein pathologic complete response has RCB = 0; residual disease is categorized into three predefined classes of RCB index [RCB-I, RCB-II, and RCB-III]), and yp-stage of residual disease. Patients were prospectively observed for survival. Three patient cohorts received paclitaxel (T) followed by fluorouracil, doxorubicin, and cyclophosphamide (T/FAC): original development cohort (T/FAC-1), validation cohort (T/FAC-2), and independent validation cohort (T/FAC-3). Another validation cohort received FAC chemotherapy only, and a fifth cohort received concurrent trastuzumab (H) with sequential paclitaxel and fluorouracil, epirubicin, and cyclophosphamide (FEC; H+T/FEC). Phenotypic subsets were defined by hormone receptor (HR) and HER2 status at diagnosis, classified as HR-positive/HER2-negative, HER2-positive (HR-negative/HER2-positive or HR-positive/HER2-positive), or triple receptor-negative. Relapse-free survival estimates were determined from Kaplan-Meier analysis and compared using the log-rank test. Results Five cohorts (T/FAC-1 [n = 219], T/FAC-2 [n = 262], T/FAC-3 [n = 342], FAC [n = 132], and H+T/FEC [n = 203]) had median event-free follow-up of 13.5, 9.1, 6.8, 16.4, and 7.1 years, respectively. Continuous RCB index was prognostic within each phenotypic subset, independent of other clinical-pathologic variables. RCB classes stratified prognostic risk overall, within each phenotypic subset, and within yp-stage categories. Estimates of 10-year relapse-free survival rates in the four RCB classes (pathologic complete response, RCB-I, RCB-II, and RCB-III) were 86%, 81%, 55%, and 23% for triple receptor-negative; 83%, 97%, 74%, and 52% for HR-positive/HER2-negative in the combined T/FAC cohorts; and 95%, 77%, 47%, and 21% in the H+T/FEC cohort. Conclusion RCB was prognostic for long-term survival after neoadjuvant chemotherapy in all three phenotypic subsets of breast cancer. Our institutional findings should be externally validated.
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Affiliation(s)
- W Fraser Symmans
- W. Fraser Symmans, Caimiao Wei, Rebekah Gould, Xian Yu, Ya Zhang, Maheshwari Ramineni, Kelly Hunt, Thomas A. Buchholz, Vicente Valero, Aman U. Buzdar, Wei Yang, Abenaa M. Brewster, Stacy Moulder, and Gabriel N. Hortobagyi, University of Texas MD Anderson Cancer Center, Houston; Andrew Walls, Uniformed Services University of the Health Sciences, San Antonio, TX; Mei Liu, The General Hospital of People's Liberation Army, Beijing, China; Alex Bousamra, Allegheny General Hospital, Pittsburgh, PA; Bruno Sinn, Charite-Universitatsmedizin, Berlin, Germany; and Lajos Pusztai and Christos Hatzis, Yale University School of Medicine, New Haven, CT
| | - Caimiao Wei
- W. Fraser Symmans, Caimiao Wei, Rebekah Gould, Xian Yu, Ya Zhang, Maheshwari Ramineni, Kelly Hunt, Thomas A. Buchholz, Vicente Valero, Aman U. Buzdar, Wei Yang, Abenaa M. Brewster, Stacy Moulder, and Gabriel N. Hortobagyi, University of Texas MD Anderson Cancer Center, Houston; Andrew Walls, Uniformed Services University of the Health Sciences, San Antonio, TX; Mei Liu, The General Hospital of People's Liberation Army, Beijing, China; Alex Bousamra, Allegheny General Hospital, Pittsburgh, PA; Bruno Sinn, Charite-Universitatsmedizin, Berlin, Germany; and Lajos Pusztai and Christos Hatzis, Yale University School of Medicine, New Haven, CT
| | - Rebekah Gould
- W. Fraser Symmans, Caimiao Wei, Rebekah Gould, Xian Yu, Ya Zhang, Maheshwari Ramineni, Kelly Hunt, Thomas A. Buchholz, Vicente Valero, Aman U. Buzdar, Wei Yang, Abenaa M. Brewster, Stacy Moulder, and Gabriel N. Hortobagyi, University of Texas MD Anderson Cancer Center, Houston; Andrew Walls, Uniformed Services University of the Health Sciences, San Antonio, TX; Mei Liu, The General Hospital of People's Liberation Army, Beijing, China; Alex Bousamra, Allegheny General Hospital, Pittsburgh, PA; Bruno Sinn, Charite-Universitatsmedizin, Berlin, Germany; and Lajos Pusztai and Christos Hatzis, Yale University School of Medicine, New Haven, CT
| | - Xian Yu
- W. Fraser Symmans, Caimiao Wei, Rebekah Gould, Xian Yu, Ya Zhang, Maheshwari Ramineni, Kelly Hunt, Thomas A. Buchholz, Vicente Valero, Aman U. Buzdar, Wei Yang, Abenaa M. Brewster, Stacy Moulder, and Gabriel N. Hortobagyi, University of Texas MD Anderson Cancer Center, Houston; Andrew Walls, Uniformed Services University of the Health Sciences, San Antonio, TX; Mei Liu, The General Hospital of People's Liberation Army, Beijing, China; Alex Bousamra, Allegheny General Hospital, Pittsburgh, PA; Bruno Sinn, Charite-Universitatsmedizin, Berlin, Germany; and Lajos Pusztai and Christos Hatzis, Yale University School of Medicine, New Haven, CT
| | - Ya Zhang
- W. Fraser Symmans, Caimiao Wei, Rebekah Gould, Xian Yu, Ya Zhang, Maheshwari Ramineni, Kelly Hunt, Thomas A. Buchholz, Vicente Valero, Aman U. Buzdar, Wei Yang, Abenaa M. Brewster, Stacy Moulder, and Gabriel N. Hortobagyi, University of Texas MD Anderson Cancer Center, Houston; Andrew Walls, Uniformed Services University of the Health Sciences, San Antonio, TX; Mei Liu, The General Hospital of People's Liberation Army, Beijing, China; Alex Bousamra, Allegheny General Hospital, Pittsburgh, PA; Bruno Sinn, Charite-Universitatsmedizin, Berlin, Germany; and Lajos Pusztai and Christos Hatzis, Yale University School of Medicine, New Haven, CT
| | - Mei Liu
- W. Fraser Symmans, Caimiao Wei, Rebekah Gould, Xian Yu, Ya Zhang, Maheshwari Ramineni, Kelly Hunt, Thomas A. Buchholz, Vicente Valero, Aman U. Buzdar, Wei Yang, Abenaa M. Brewster, Stacy Moulder, and Gabriel N. Hortobagyi, University of Texas MD Anderson Cancer Center, Houston; Andrew Walls, Uniformed Services University of the Health Sciences, San Antonio, TX; Mei Liu, The General Hospital of People's Liberation Army, Beijing, China; Alex Bousamra, Allegheny General Hospital, Pittsburgh, PA; Bruno Sinn, Charite-Universitatsmedizin, Berlin, Germany; and Lajos Pusztai and Christos Hatzis, Yale University School of Medicine, New Haven, CT
| | - Andrew Walls
- W. Fraser Symmans, Caimiao Wei, Rebekah Gould, Xian Yu, Ya Zhang, Maheshwari Ramineni, Kelly Hunt, Thomas A. Buchholz, Vicente Valero, Aman U. Buzdar, Wei Yang, Abenaa M. Brewster, Stacy Moulder, and Gabriel N. Hortobagyi, University of Texas MD Anderson Cancer Center, Houston; Andrew Walls, Uniformed Services University of the Health Sciences, San Antonio, TX; Mei Liu, The General Hospital of People's Liberation Army, Beijing, China; Alex Bousamra, Allegheny General Hospital, Pittsburgh, PA; Bruno Sinn, Charite-Universitatsmedizin, Berlin, Germany; and Lajos Pusztai and Christos Hatzis, Yale University School of Medicine, New Haven, CT
| | - Alex Bousamra
- W. Fraser Symmans, Caimiao Wei, Rebekah Gould, Xian Yu, Ya Zhang, Maheshwari Ramineni, Kelly Hunt, Thomas A. Buchholz, Vicente Valero, Aman U. Buzdar, Wei Yang, Abenaa M. Brewster, Stacy Moulder, and Gabriel N. Hortobagyi, University of Texas MD Anderson Cancer Center, Houston; Andrew Walls, Uniformed Services University of the Health Sciences, San Antonio, TX; Mei Liu, The General Hospital of People's Liberation Army, Beijing, China; Alex Bousamra, Allegheny General Hospital, Pittsburgh, PA; Bruno Sinn, Charite-Universitatsmedizin, Berlin, Germany; and Lajos Pusztai and Christos Hatzis, Yale University School of Medicine, New Haven, CT
| | - Maheshwari Ramineni
- W. Fraser Symmans, Caimiao Wei, Rebekah Gould, Xian Yu, Ya Zhang, Maheshwari Ramineni, Kelly Hunt, Thomas A. Buchholz, Vicente Valero, Aman U. Buzdar, Wei Yang, Abenaa M. Brewster, Stacy Moulder, and Gabriel N. Hortobagyi, University of Texas MD Anderson Cancer Center, Houston; Andrew Walls, Uniformed Services University of the Health Sciences, San Antonio, TX; Mei Liu, The General Hospital of People's Liberation Army, Beijing, China; Alex Bousamra, Allegheny General Hospital, Pittsburgh, PA; Bruno Sinn, Charite-Universitatsmedizin, Berlin, Germany; and Lajos Pusztai and Christos Hatzis, Yale University School of Medicine, New Haven, CT
| | - Bruno Sinn
- W. Fraser Symmans, Caimiao Wei, Rebekah Gould, Xian Yu, Ya Zhang, Maheshwari Ramineni, Kelly Hunt, Thomas A. Buchholz, Vicente Valero, Aman U. Buzdar, Wei Yang, Abenaa M. Brewster, Stacy Moulder, and Gabriel N. Hortobagyi, University of Texas MD Anderson Cancer Center, Houston; Andrew Walls, Uniformed Services University of the Health Sciences, San Antonio, TX; Mei Liu, The General Hospital of People's Liberation Army, Beijing, China; Alex Bousamra, Allegheny General Hospital, Pittsburgh, PA; Bruno Sinn, Charite-Universitatsmedizin, Berlin, Germany; and Lajos Pusztai and Christos Hatzis, Yale University School of Medicine, New Haven, CT
| | - Kelly Hunt
- W. Fraser Symmans, Caimiao Wei, Rebekah Gould, Xian Yu, Ya Zhang, Maheshwari Ramineni, Kelly Hunt, Thomas A. Buchholz, Vicente Valero, Aman U. Buzdar, Wei Yang, Abenaa M. Brewster, Stacy Moulder, and Gabriel N. Hortobagyi, University of Texas MD Anderson Cancer Center, Houston; Andrew Walls, Uniformed Services University of the Health Sciences, San Antonio, TX; Mei Liu, The General Hospital of People's Liberation Army, Beijing, China; Alex Bousamra, Allegheny General Hospital, Pittsburgh, PA; Bruno Sinn, Charite-Universitatsmedizin, Berlin, Germany; and Lajos Pusztai and Christos Hatzis, Yale University School of Medicine, New Haven, CT
| | - Thomas A Buchholz
- W. Fraser Symmans, Caimiao Wei, Rebekah Gould, Xian Yu, Ya Zhang, Maheshwari Ramineni, Kelly Hunt, Thomas A. Buchholz, Vicente Valero, Aman U. Buzdar, Wei Yang, Abenaa M. Brewster, Stacy Moulder, and Gabriel N. Hortobagyi, University of Texas MD Anderson Cancer Center, Houston; Andrew Walls, Uniformed Services University of the Health Sciences, San Antonio, TX; Mei Liu, The General Hospital of People's Liberation Army, Beijing, China; Alex Bousamra, Allegheny General Hospital, Pittsburgh, PA; Bruno Sinn, Charite-Universitatsmedizin, Berlin, Germany; and Lajos Pusztai and Christos Hatzis, Yale University School of Medicine, New Haven, CT
| | - Vicente Valero
- W. Fraser Symmans, Caimiao Wei, Rebekah Gould, Xian Yu, Ya Zhang, Maheshwari Ramineni, Kelly Hunt, Thomas A. Buchholz, Vicente Valero, Aman U. Buzdar, Wei Yang, Abenaa M. Brewster, Stacy Moulder, and Gabriel N. Hortobagyi, University of Texas MD Anderson Cancer Center, Houston; Andrew Walls, Uniformed Services University of the Health Sciences, San Antonio, TX; Mei Liu, The General Hospital of People's Liberation Army, Beijing, China; Alex Bousamra, Allegheny General Hospital, Pittsburgh, PA; Bruno Sinn, Charite-Universitatsmedizin, Berlin, Germany; and Lajos Pusztai and Christos Hatzis, Yale University School of Medicine, New Haven, CT
| | - Aman U Buzdar
- W. Fraser Symmans, Caimiao Wei, Rebekah Gould, Xian Yu, Ya Zhang, Maheshwari Ramineni, Kelly Hunt, Thomas A. Buchholz, Vicente Valero, Aman U. Buzdar, Wei Yang, Abenaa M. Brewster, Stacy Moulder, and Gabriel N. Hortobagyi, University of Texas MD Anderson Cancer Center, Houston; Andrew Walls, Uniformed Services University of the Health Sciences, San Antonio, TX; Mei Liu, The General Hospital of People's Liberation Army, Beijing, China; Alex Bousamra, Allegheny General Hospital, Pittsburgh, PA; Bruno Sinn, Charite-Universitatsmedizin, Berlin, Germany; and Lajos Pusztai and Christos Hatzis, Yale University School of Medicine, New Haven, CT
| | - Wei Yang
- W. Fraser Symmans, Caimiao Wei, Rebekah Gould, Xian Yu, Ya Zhang, Maheshwari Ramineni, Kelly Hunt, Thomas A. Buchholz, Vicente Valero, Aman U. Buzdar, Wei Yang, Abenaa M. Brewster, Stacy Moulder, and Gabriel N. Hortobagyi, University of Texas MD Anderson Cancer Center, Houston; Andrew Walls, Uniformed Services University of the Health Sciences, San Antonio, TX; Mei Liu, The General Hospital of People's Liberation Army, Beijing, China; Alex Bousamra, Allegheny General Hospital, Pittsburgh, PA; Bruno Sinn, Charite-Universitatsmedizin, Berlin, Germany; and Lajos Pusztai and Christos Hatzis, Yale University School of Medicine, New Haven, CT
| | - Abenaa M Brewster
- W. Fraser Symmans, Caimiao Wei, Rebekah Gould, Xian Yu, Ya Zhang, Maheshwari Ramineni, Kelly Hunt, Thomas A. Buchholz, Vicente Valero, Aman U. Buzdar, Wei Yang, Abenaa M. Brewster, Stacy Moulder, and Gabriel N. Hortobagyi, University of Texas MD Anderson Cancer Center, Houston; Andrew Walls, Uniformed Services University of the Health Sciences, San Antonio, TX; Mei Liu, The General Hospital of People's Liberation Army, Beijing, China; Alex Bousamra, Allegheny General Hospital, Pittsburgh, PA; Bruno Sinn, Charite-Universitatsmedizin, Berlin, Germany; and Lajos Pusztai and Christos Hatzis, Yale University School of Medicine, New Haven, CT
| | - Stacy Moulder
- W. Fraser Symmans, Caimiao Wei, Rebekah Gould, Xian Yu, Ya Zhang, Maheshwari Ramineni, Kelly Hunt, Thomas A. Buchholz, Vicente Valero, Aman U. Buzdar, Wei Yang, Abenaa M. Brewster, Stacy Moulder, and Gabriel N. Hortobagyi, University of Texas MD Anderson Cancer Center, Houston; Andrew Walls, Uniformed Services University of the Health Sciences, San Antonio, TX; Mei Liu, The General Hospital of People's Liberation Army, Beijing, China; Alex Bousamra, Allegheny General Hospital, Pittsburgh, PA; Bruno Sinn, Charite-Universitatsmedizin, Berlin, Germany; and Lajos Pusztai and Christos Hatzis, Yale University School of Medicine, New Haven, CT
| | - Lajos Pusztai
- W. Fraser Symmans, Caimiao Wei, Rebekah Gould, Xian Yu, Ya Zhang, Maheshwari Ramineni, Kelly Hunt, Thomas A. Buchholz, Vicente Valero, Aman U. Buzdar, Wei Yang, Abenaa M. Brewster, Stacy Moulder, and Gabriel N. Hortobagyi, University of Texas MD Anderson Cancer Center, Houston; Andrew Walls, Uniformed Services University of the Health Sciences, San Antonio, TX; Mei Liu, The General Hospital of People's Liberation Army, Beijing, China; Alex Bousamra, Allegheny General Hospital, Pittsburgh, PA; Bruno Sinn, Charite-Universitatsmedizin, Berlin, Germany; and Lajos Pusztai and Christos Hatzis, Yale University School of Medicine, New Haven, CT
| | - Christos Hatzis
- W. Fraser Symmans, Caimiao Wei, Rebekah Gould, Xian Yu, Ya Zhang, Maheshwari Ramineni, Kelly Hunt, Thomas A. Buchholz, Vicente Valero, Aman U. Buzdar, Wei Yang, Abenaa M. Brewster, Stacy Moulder, and Gabriel N. Hortobagyi, University of Texas MD Anderson Cancer Center, Houston; Andrew Walls, Uniformed Services University of the Health Sciences, San Antonio, TX; Mei Liu, The General Hospital of People's Liberation Army, Beijing, China; Alex Bousamra, Allegheny General Hospital, Pittsburgh, PA; Bruno Sinn, Charite-Universitatsmedizin, Berlin, Germany; and Lajos Pusztai and Christos Hatzis, Yale University School of Medicine, New Haven, CT
| | - Gabriel N Hortobagyi
- W. Fraser Symmans, Caimiao Wei, Rebekah Gould, Xian Yu, Ya Zhang, Maheshwari Ramineni, Kelly Hunt, Thomas A. Buchholz, Vicente Valero, Aman U. Buzdar, Wei Yang, Abenaa M. Brewster, Stacy Moulder, and Gabriel N. Hortobagyi, University of Texas MD Anderson Cancer Center, Houston; Andrew Walls, Uniformed Services University of the Health Sciences, San Antonio, TX; Mei Liu, The General Hospital of People's Liberation Army, Beijing, China; Alex Bousamra, Allegheny General Hospital, Pittsburgh, PA; Bruno Sinn, Charite-Universitatsmedizin, Berlin, Germany; and Lajos Pusztai and Christos Hatzis, Yale University School of Medicine, New Haven, CT
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Choi M, Park YH, Ahn JS, Im YH, Nam SJ, Cho SY, Cho EY. Evaluation of Pathologic Complete Response in Breast Cancer Patients Treated with Neoadjuvant Chemotherapy: Experience in a Single Institution over a 10-Year Period. J Pathol Transl Med 2016; 51:69-78. [PMID: 28013533 PMCID: PMC5267543 DOI: 10.4132/jptm.2016.10.05] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 10/04/2016] [Accepted: 10/05/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) has been associated with favorable clinical outcome in breast cancer patients. However, the possibility that the prognostic significance of pCR differs among various definitions has not been established. METHODS We retrospectively evaluated the pathologic response after NAC in 353 breast cancer patients and compared the prognoses after applying the following different definitions of pCR: ypT0/is, ypT0, ypT0/is ypN0, and ypT0 ypN0. RESULTS pCR was significantly associated with improved distant disease-free survival (DDFS) regardless of the definition (ypT0/is, p = .002; ypT0, p = .008; ypT0/is ypN0, p < .001; ypT0 ypN0, p = .003). Presence of tumor deposits of any size in the lymph nodes (LNs; ypN ≥ 0(i+)) was associated with worse DDFS (ypT0 ypN0 vs ypT0 ypN ≥ 0(i+), p = .036 and ypT0/is ypN0 vs ypT0/is ypN ≥ 0(i+), p = .015), and presence of isolated tumor cells was associated with decreased overall survival (OS; ypT0/is ypN0 vs ypT0/is ypN0(i+), p = .013). Residual ductal carcinoma in situ regardless of LN status showed no significant difference in DDFS or OS (DDFS: ypT0 vs ypTis, p = .373 and ypT0 ypN0 vs ypTis ypN0, p = .462; OS: ypT0 vs ypTis, p = .441 and ypT0 ypN0 vs ypTis ypN0, p = .758). In subsequent analysis using ypT0/is ypN0, pCR was associated with improved DDFS and OS in triple-negative tumors (p < .001 and p = .003, respectively). CONCLUSIONS Based on our study results, the prognosis and rate of pCR differ according to the definition of pCR and ypT0/is ypN0 might be considered a more preferable definition of pCR.
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Affiliation(s)
- Misun Choi
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yeon Hee Park
- Division of Hematology-Oncology,Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Seok Ahn
- Division of Hematology-Oncology,Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Hyuck Im
- Division of Hematology-Oncology,Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok Jin Nam
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Youn Cho
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Yoon Cho
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Ma Y, Zhang S, Zang L, Li J, Li J, Kang Y, Ren W. Combination of shear wave elastography and Ki-67 index as a novel predictive modality for the pathological response to neoadjuvant chemotherapy in patients with invasive breast cancer. Eur J Cancer 2016; 69:86-101. [PMID: 27821323 DOI: 10.1016/j.ejca.2016.09.031] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 08/03/2016] [Accepted: 09/26/2016] [Indexed: 12/17/2022]
Abstract
PURPOSE This study evaluated shear wave elastography (SWE) and SWE combined with the Ki-67 index as novel predictive modalities for the pathological response of invasive breast cancer to neoadjuvant chemotherapy (NAC). METHODS The prospective study recruited 66 eligible patients from July 2014 to November 2015. Tumour stiffness, which corresponds with tumour progression and invasiveness, was assessed by quantitative SWE 1 d before biopsy (time point t0, elasticity E0), 1 d before next NAC cycle (t1-t5, E1-E5), and 1 d before surgery (t6, E6). The relative changes in SWE parameters after the first and second NAC cycles were considered as the variables [ΔE (t1), ΔE (t2)]. The pathological response was classified according to the residual cancer burden (RCB) protocol. Correlations between RCB scores and variables were evaluated. The predictive diagnostic performances of SWE parameters, Ki-67 index, and the predictive RCB (predRCB) score determined by a linear regression model were compared. RESULTS Some immunohistochemical and molecular factors and SWE parameters were significantly different among the three RCB groups. The ΔEmean (t2) and Ki-67 had significantly better diagnostic performance than other parameters regarding predicting the pathological response (the RCB-I response and RCB-III resistance). However, the correlation between ΔEmean (t2) and Ki-67 index was significantly weaker as a diagnostic predictor (r = 0.29). We generated a new predictive modality, predRCB, which is a multivariable linear regression model that combines ΔEmean (t2) and the Ki-67 index. The predRCB modality showed better diagnostic performance than SWE parameters and Ki-67 index alone. CONCLUSION Our findings highlight the potential utility for adding the Ki-67 index to the SWE results, which may improve the predictive power of SWE and facilitate personalising the treatment regimens of patients with breast cancer. These results should be validated in the future by performing a multicentre prospective study with a larger cohort.
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Affiliation(s)
- Yan Ma
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, China
| | - Shuo Zhang
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, China
| | - Li Zang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, China
| | - Jing Li
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, China
| | - Jianyi Li
- Department of Breast Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, China
| | - Ye Kang
- Department of Pathology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, China
| | - Weidong Ren
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, China.
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Bubis G, Rath-Wolfson L, Schwartz A, Girich S, Koren R. Visualization of Grossly Undetectable Breast Tumors by Refixation in Lymph Node Revealing Solution. Int J Surg Pathol 2016; 24:692-695. [PMID: 27305939 DOI: 10.1177/1066896916653672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Breast lesions might be missed by the traditional method of inspection, palpation, and sectioning of the specimen. Lymph node revealing solution (LNRS) was first introduced by us as a fixative that enhances the retrieval of lymph nodes in breast carcinoma and other malignancies. This is a preliminary report of our experience with the use of LNRS in order to visualize malignant breast tumors that were not detected by the traditional method. Material and Methods Eight post-chemoradiation-treated tumors, 6 relumpectomy specimens, and 1 post mammotome lumpectomy with no grossly detectable residual tumor and 2 mastectomy specimens with multifocal tumors which were missed by the first inspection were postfixed in LNRS for 24 hours and sectioned. Results In some of the cases, small tumors up to 0.5 cm were visualized as white gray lesions. Carcinoma has been confirmed by histopathologic examination and the final diagnosis had to be changed. Conclusion Postfixation in LNRS enhances the visualization of grossly undetectable breast lesions and it is worthwhile to use it in problematic cases in order to arrive at a more accurate diagnosis.
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Affiliation(s)
- Golan Bubis
- St George's University of London, University of Nicosia, Nicosia, Cyprus
| | - Lea Rath-Wolfson
- Rabin Medical Center, Hasharon Hospital, Petah-Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Schwartz
- Rabin Medical Center, Hasharon Hospital, Petah-Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sasha Girich
- Rabin Medical Center, Hasharon Hospital, Petah-Tiqva, Israel
| | - Rumelia Koren
- Rabin Medical Center, Hasharon Hospital, Petah-Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Diaz-Botero S, Espinosa-Bravo M, Gonçalves VR, Esgueva-Colmenarejo A, Peg V, Perez J, Cortes J, Rubio IT. Different Prognostic Implications of Residual Disease After Neoadjuvant Treatment: Impact of Ki 67 and Site of Response. Ann Surg Oncol 2016; 23:3831-3837. [DOI: 10.1245/s10434-016-5339-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Assessment of pathologic response and long-term outcome in locally advanced breast cancers after neoadjuvant chemotherapy: comparison of pathologic classification systems. Breast Cancer Res Treat 2016; 160:475-489. [PMID: 27730423 DOI: 10.1007/s10549-016-4008-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 10/03/2016] [Indexed: 01/03/2023]
Abstract
PURPOSE Several pathologic classification systems have been developed to evaluate tumor response after neoadjuvant chemotherapy (NAC) for breast cancer. We aimed to compare pathologic classification systems and to investigate prognostic factors and risk stratification according to molecular subtype in relation to survival. METHODS We retrospectively evaluated pathologic response after NAC in 485 breast cancer patients by applying the National Surgical Adjuvant Breast and Bowel Project B18 trial (NSABP-B18), Miller and Payne system, Chevallier's classification, Sataloff's classification, residual cancer burden (RCB), residual disease in breast and nodes (RDBN), and clinical-pathologic stage + estrogen receptor status and grade staging system (CPS + EG). RESULTS All seven classification systems were significantly associated with overall survival (OS) and distant disease-free survival (DDFS). Regarding intrinsic subtypes, all systems were significantly associated with OS and DDFS for triple-negative tumors. Only RCB had prognostic significance for all four subtypes in relation to both OS and DDFS, and RDBN in DDFS only for all subtypes. In risk factor analyses, lymphovascular invasion (LVI), as well as other classic pathologic prognostic factors such as tumor size, lymph node status, and hormonal receptor status, was significantly associated with both OS and DDFS for the entire study group. Regarding subtypes, LVI was associated with DDFS for each subtype except Luminal B-like tumors. CONCLUSIONS Our results suggest that pathologic classification systems that evaluate residual tumors in both breast and lymph nodes after NAC show better association with clinical outcome. Furthermore, combining LVI with other classic prognostic factors might have prognostic value for the assessment of treatment response after NAC.
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30
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van Walraven C, McAlister FA. Competing risk bias was common in Kaplan–Meier risk estimates published in prominent medical journals. J Clin Epidemiol 2016; 69:170-3.e8. [DOI: 10.1016/j.jclinepi.2015.07.006] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 06/26/2015] [Accepted: 07/20/2015] [Indexed: 02/07/2023]
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Multiparametric magnetic resonance imaging for predicting pathological response after the first cycle of neoadjuvant chemotherapy in breast cancer. Invest Radiol 2015; 50:195-204. [PMID: 25360603 DOI: 10.1097/rli.0000000000000100] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES The purpose of this study was to determine whether multiparametric magnetic resonance imaging (MRI) using dynamic contrast-enhanced MRI (DCE-MRI) and diffusion-weighted MRI (DWI), obtained before and after the first cycle of neoadjuvant chemotherapy (NAC), is superior to single-parameter measurements for predicting pathologic complete response (pCR) in patients with breast cancer. MATERIALS AND METHODS Patients with stage II/III breast cancer were enrolled in an institutional review board-approved study in which 3-T DCE-MRI and DWI data were acquired before (n = 42) and after 1 cycle (n = 36) of NAC. Estimates of the volume transfer rate (K), extravascular extracellular volume fraction (ve), blood plasma volume fraction (vp), and the efflux rate constant (kep = K/ve) were generated from the DCE-MRI data using the Extended Tofts-Kety model. The apparent diffusion coefficient (ADC) was estimated from the DWI data. The derived parameter kep/ADC was compared with single-parameter measurements for its ability to predict pCR after the first cycle of NAC. RESULTS The kep/ADC after the first cycle of NAC discriminated patients who went on to achieve a pCR (P < 0.001) and achieved a sensitivity, specificity, positive predictive value, and area under the receiver operator curve (AUC) of 0.92, 0.78, 0.69, and 0.88, respectively. These values were superior to the single parameters kep (AUC, 0.76) and ADC (AUC, 0.82). The AUCs between kep/ADC and kep were significantly different on the basis of the bootstrapped 95% confidence intervals (0.018-0.23), whereas the AUCs between kep/ADC and ADC trended toward significance (-0.11 to 0.24). CONCLUSIONS The multiparametric analysis of DCE-MRI and DWI was superior to the single-parameter measurements for predicting pCR after the first cycle of NAC.
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Prognostic value of pathological response to neoadjuvant chemotherapy in bulky stage Ib2 and IIa cervical squamous cell cancer patients. Virchows Arch 2015; 468:329-36. [PMID: 26637198 DOI: 10.1007/s00428-015-1888-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 10/22/2015] [Accepted: 11/22/2015] [Indexed: 12/20/2022]
Abstract
Neoadjuvant chemotherapy (NAC) is widely used to treat patients with locally advanced cervical cancer. Optimal pathological response to neoadjuvant therapy has proven to be a good prognostic indicator for patient survival, but the prognostic significance of a partial response remains unclear. The aim of this study was to identify prognostic predictors for patients with partial response. We included in the study 190 patients with bulky stage Ib2 or IIa cervical squamous cell cancer, who underwent neoadjuvant chemotherapy followed by surgery. A novel pathological grading system, including optimal response (complete disappearance of tumor, grade 1), viable tumor cells occupying <(2)/3 (grade 2) or >(2)/3 (grade 3) of the tumor bed area and extra-cervical tumor deposits (grade 4), was developed and associations with disease-free survival and overall survival were studied. Survival analysis was conducted using log-rank testing and Cox regression analysis. We found statistically significant differences between 4 different pathological response groups both in terms of disease-free survival (p = 0.001) and overall survival (p = 0.003). Combining adjacent survival curves in the pathological grading system allowed us to identify response grade 2 patients with disease-free and overall survival similar to those of optimal response patients (p = 0.000, p = 0.002). Multivariate analyses showed that the pathological response grading system is the only independent predictor for progression-free survival and overall survival (p = 0.001 and p = 0.007). A response grading system based on pathological parameters may be useful to predict both progression-free and overall survival in bulky stage Ib2 and IIa cervical squamous cell cancer patients treated with NAC.
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Comparison of Pathologic Response Evaluation Systems after Anthracycline with/without Taxane-Based Neoadjuvant Chemotherapy among Different Subtypes of Breast Cancers. PLoS One 2015; 10:e0137885. [PMID: 26394326 PMCID: PMC4578929 DOI: 10.1371/journal.pone.0137885] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 08/24/2015] [Indexed: 11/19/2022] Open
Abstract
Purpose Several methods are used to assess the pathologic response of breast cancer after neoadjuvant chemotherapy (NAC) to predict clinical outcome. However, the clinical utility of these systems for each molecular subtype of breast cancer is unclear. Therefore, we applied six pathologic response assessment systems to specific subtypes of breast cancer and compared the results. Patients and Methods Five hundred and eighty eight breast cancer patients treated with anthracycline with/without taxane-based NAC were retrospectively analyzed, and the ypTNM stage, residual cancer burden (RCB), residual disease in breast and nodes (RDBN), tumor response ratio, Sataloff’s classification, and Miller—Payne grading system were evaluated. The results obtained for each assessment system were analyzed in terms of patient survival. Results In triple-negative tumors, all systems were significantly associated with disease-free survival and Kaplan-Meier survival curves for disease-free survival were clearly separated by all assessment methods. For HR+/HER2- tumors, systems assessing the residual tumor (ypTNM stage, RCB, and RDBN) had prognostic significance. However, for HER2+ tumors, the association between patient survival and the pathologic response assessment results varied according to the system used, and none resulted in distinct Kaplan—Meier curves. Conclusion Most of the currently available pathologic assessment systems used after anthracycline with/without taxane-based NAC effectively classified triple-negative breast cancers into groups showing different prognoses. The pathologic assessment systems evaluating residual tumors only also had prognostic significance in HR+/HER2- tumors. However, new assessment methods are required to effectively evaluate the pathologic response of HR+/HER2+ and HR-/HER2+ tumors to anthracycline with/without taxane-based NAC.
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34
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Li WL, Zhang Y, Liu BG, DU Q, Zhou CX, Tian XS. Correlation between the expression of S100A4 and the efficacy of TAC neoadjuvant chemotherapy in breast cancer. Exp Ther Med 2015; 10:1983-1989. [PMID: 26640584 DOI: 10.3892/etm.2015.2743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 08/03/2015] [Indexed: 11/05/2022] Open
Abstract
The aim of this study was to investigate the correlation between the expression of S100A4 and the efficacy of neoadjuvant chemotherapy in breast cancer. A total of 65 patients with invasive breast cancer were treated with neoadjuvant chemotherapy using the TAC regimen. The expression of S100A4 was detected by an immunohistochemical two-step method prior to treatment, after 2 cycles of chemotherapy and after 4 cycles of chemotherapy. Pathological evaluations of the chemotherapy were performed using the Miller and Payne (MP) grading system and their correlation with the changes of S100A4 expression during and after the treatment were explored. Between pre-neoadjuvant chemotherapy and 4 cycles post-chemotherapy, there was a significant difference in the expression of S100A4 (P<0.05); S100A4 expression was associated with neoadjuvant chemotherapy. However, between pre-neoadjuvant chemotherapy and 2 cycles post-chemotherapy, there was no significant difference in the expression of S100A4 (P>0.05). The intensity and changes of S100A4 expression were positively correlated with the efficacy of neoadjuvant chemotherapy (r=0.259, P<0.05). When patients with an MP grade of I or II following the second cycle of neoadjuvant chemotherapy were continually treated with the original chemotherapy for another 2 cycles, the desired effect was generally not achieved. S100A4 may be used as a predictor of the efficacy of neoadjuvant chemotherapy in breast cancer, guiding the formulation of individualized programs to improve the effectiveness of the treatment. For patients with an MP grade level of I or II after 2 cycles of neoadjuvant chemotherapy, the use of alternative chemotherapy regimens should be considered.
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Affiliation(s)
- Wen-Lei Li
- Department of Breast and Thyroid Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong 250021, P.R. China ; Department of Breast and Thyroid Surgery, People's Hospital of Liaocheng, Liaocheng, Shandong 252000, P.R. China
| | - Yang Zhang
- Department of Breast and Thyroid Surgery, People's Hospital of Liaocheng, Liaocheng, Shandong 252000, P.R. China
| | - Bao-Guo Liu
- Department of Breast and Thyroid Surgery, People's Hospital of Liaocheng, Liaocheng, Shandong 252000, P.R. China
| | - Qian DU
- Department of Pediatrics, People's Hospital of Liaocheng, Liaocheng, Shandong 252000, P.R. China
| | - Chang-Xin Zhou
- Department of Breast and Thyroid Surgery, People's Hospital of Liaocheng, Liaocheng, Shandong 252000, P.R. China
| | - Xing-Song Tian
- Department of Breast and Thyroid Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong 250021, P.R. China
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Provenzano E, Bossuyt V, Viale G, Cameron D, Badve S, Denkert C, MacGrogan G, Penault-Llorca F, Boughey J, Curigliano G, Dixon JM, Esserman L, Fastner G, Kuehn T, Peintinger F, von Minckwitz G, White J, Yang W, Symmans WF. Standardization of pathologic evaluation and reporting of postneoadjuvant specimens in clinical trials of breast cancer: recommendations from an international working group. Mod Pathol 2015; 28:1185-201. [PMID: 26205180 DOI: 10.1038/modpathol.2015.74] [Citation(s) in RCA: 173] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 03/09/2015] [Indexed: 01/02/2023]
Abstract
Neoadjuvant systemic therapy is being used increasingly in the treatment of early-stage breast cancer. Response, in the form of pathological complete response, is a validated and evaluable surrogate end point of survival after neoadjuvant therapy. Thus, pathological complete response has become a primary end point for clinical trials. However, there is a current lack of uniformity in the definition of pathological complete response. A review of standard operating procedures used by 28 major neoadjuvant breast cancer trials and/or 25 sites involved in such trials identified marked variability in specimen handling and histologic reporting. An international working group was convened to develop practical recommendations for the pathologic assessment of residual disease in neoadjuvant clinical trials of breast cancer and information expected from pathology reports. Systematic sampling of areas identified by informed mapping of the specimen and close correlation with radiological findings is preferable to overly exhaustive sampling, and permits taking tissue samples for translational research. Controversial areas are discussed, including measurement of lesion size, reporting of lymphovascular space invasion and the presence of isolated tumor cells in lymph nodes after neoadjuvant therapy, and retesting of markers after treatment. If there has been a pathological complete response, this must be clearly stated, and the presence/absence of residual ductal carcinoma in situ must be described. When there is residual invasive carcinoma, a comment must be made as to the presence/absence of chemotherapy effect in the breast and lymph nodes. The Residual Cancer Burden is the preferred method for quantifying residual disease in neoadjuvant clinical trials in breast cancer; other methods can be included per trial protocols and regional preference. Posttreatment tumor staging using the Tumor-Node-Metastasis system should be included. These recommendations for standardized pathological evaluation and reporting of neoadjuvant breast cancer specimens should improve prognostication for individual patients and allow comparison of treatment outcomes within and across clinical trials.
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Affiliation(s)
- Elena Provenzano
- Department of Histopathology and NIH Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK
| | - Veerle Bossuyt
- Department of Pathology, Yale University, New Haven, CT, USA
| | - Giuseppe Viale
- Department of Pathology, European Institute of Oncology and University of Milan, Milan, Italy
| | - David Cameron
- Edinburgh Cancer Research UK Centre,University of Edinburgh, Edinburgh, UK
| | - Sunil Badve
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | | | - Judy Boughey
- Division of Subspecialty General Surgery, Mayo Clinic, Rochester, MN, USA
| | - Giuseppe Curigliano
- Early Drug Development for Innovative Therapies Division, European Institute of Oncology, Milan, Italy
| | - J Michael Dixon
- Edinburgh Breast Unit, Western General Hospital, Edinburgh, UK
| | - Laura Esserman
- Carol Franc Buck Breast Care Center, University of California, San Francisco, CA, USA
| | - Gerd Fastner
- Department of Radiotherapy and Radiation Oncology, Landeskrankenhaus, Paracelsus Medical University, Salzburg, Austria
| | - Thorsten Kuehn
- Department of Gynecology and Obstetrics, Interdisciplinary Breast Center, Klinikum Esslingen, Esslingen, Germany
| | - Florentia Peintinger
- Institute of Pathology, Medical University of Graz, Graz, Austria.,Department of Gynecology, General Hospital Leoben, Leoben, Austria
| | - Gunter von Minckwitz
- German Breast Group, Neu-Isenburg, and Department of Gynecology and Obstetrics, University Women's Hospital, Frankfurt, Germany
| | - Julia White
- Department of Radiation Oncology, Ohio State University, Columbus, OH, USA
| | - Wei Yang
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - W Fraser Symmans
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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36
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McCluggage WG, Judge MJ, Clarke BA, Davidson B, Gilks CB, Hollema H, Ledermann JA, Matias-Guiu X, Mikami Y, Stewart CJR, Vang R, Hirschowitz L. Data set for reporting of ovary, fallopian tube and primary peritoneal carcinoma: recommendations from the International Collaboration on Cancer Reporting (ICCR). Mod Pathol 2015; 28:1101-22. [PMID: 26089092 DOI: 10.1038/modpathol.2015.77] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 02/24/2015] [Accepted: 02/25/2015] [Indexed: 12/20/2022]
Abstract
A comprehensive pathological report is essential for optimal patient management, cancer staging and prognostication. In many countries, proforma reports are used but these vary in their content. The International Collaboration on Cancer Reporting (ICCR) is an alliance formed by the Royal College of Pathologists of Australasia, the Royal College of Pathologists of the United Kingdom, the College of American Pathologists, the Canadian Partnership Against Cancer and the European Society of Pathology, with the aim of developing an evidence-based reporting data set for each cancer site. This will reduce the global burden of cancer data set development and reduplication of effort by different international institutions that commission, publish and maintain standardised cancer reporting data sets. The resultant standardisation of cancer reporting will benefit not only those countries directly involved in the collaboration but also others not in a position to develop their own data sets. We describe the development of a cancer data set by the ICCR expert panel for the reporting of primary ovarian, fallopian tube and peritoneal carcinoma and present the 'required' and 'recommended' elements to be included in the report with an explanatory commentary. This data set encompasses the recent International Federation of Obstetricians and Gynaecologists staging system for these neoplasms and the updated World Health Organisation Classification of Tumours of the Female Reproductive Organs. The data set also addresses issues about site assignment of the primary tumour in high-grade serous carcinomas and proposes a scoring system for the assessment of tumour response to neoadjuvant chemotherapy. The widespread implementation of this data set will facilitate consistent and accurate data collection, comparison of epidemiological and pathological parameters between different populations, facilitate research and hopefully will result in improved patient management.
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Affiliation(s)
- W Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, UK
| | - Meagan J Judge
- Royal College of Pathologists of Australasia, Sydney, NSW, Australia
| | - Blaise A Clarke
- Department of Pathology and Laboratory Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Ben Davidson
- 1] Department of Pathology, Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway [2] Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - C Blake Gilks
- Department of Pathology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Harry Hollema
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Xavier Matias-Guiu
- Department of Pathology and Molecular Genetics and Research Laboratory, Hospital Universitari Arnau de Vilanova, University of Lleida, IRBLleida, Lleida, Spain
| | - Yoshiki Mikami
- Department of Diagnostic Pathology, Kumamoto University Hospital, Kumamoto, Japan
| | - Colin J R Stewart
- 1] Department of Histopathology, King Edward Memorial Hospital, Perth, WA, Australia [2] School for Women's and Infant's Health, University of Western Australia, Crawley, WA, Australia
| | - Russell Vang
- Department of Pathology (Division of Gynecologic Pathology), The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lynn Hirschowitz
- Department of Cellular Pathology, Birmingham Women's Hospital, Birmingham, UK
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Proliferation rate and breast cancer subtype, but not ALDH1 expression, predict pathological response to neoadjuvant chemotherapy in locally advanced breast cancer. Virchows Arch 2015; 467:303-10. [PMID: 26063415 DOI: 10.1007/s00428-015-1794-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 04/23/2015] [Accepted: 05/28/2015] [Indexed: 01/16/2023]
Abstract
For locally advanced breast cancer, pathological complete response (pCR) following neoadjuvant chemotherapy (NACT) is associated with good disease-free survival. In several studies, response to chemotherapy according to various parameters has shown strong inter-individual variability. We investigated whether different prognostic factors, including ALDH1 expression, might predict response to NACT in female patients with locally advanced breast carcinoma. ER, PR, Her2/neu, Ki-67 and ALDH1 immunohistochemistry were performed on the initial biopsy and subsequent resection specimens. Residual tumour burden was calculated in post NACT resection specimens using residual cancer burden (RCB) protocol. Of our cohort of 66 patients, 24 (36 %) achieved pCR. Triple negative phenotype and high Ki-67 proliferative index (>40 %) were significantly associated with good response to NACT. ALDH1 expression in tumour epithelial (20 %) or stromal (44 %) cells did not correlate with tumour grade, molecular subtype, proliferative index or NACT response. However, epithelial and stromal ALDH1 expression was significantly increased in residual tumour after NACT. In conclusion, triple negative phenotype and high proliferative index, but not ALDH1 expression, are predictive of good pathological response to NACT. Increased ALDH1 expression following NACT might be associated with a higher probability of recurrent disease.
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38
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Bossuyt V, Provenzano E, Symmans WF, Boughey JC, Coles C, Curigliano G, Dixon JM, Esserman LJ, Fastner G, Kuehn T, Peintinger F, von Minckwitz G, White J, Yang W, Badve S, Denkert C, MacGrogan G, Penault-Llorca F, Viale G, Cameron D. Recommendations for standardized pathological characterization of residual disease for neoadjuvant clinical trials of breast cancer by the BIG-NABCG collaboration. Ann Oncol 2015; 26:1280-91. [PMID: 26019189 DOI: 10.1093/annonc/mdv161] [Citation(s) in RCA: 148] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 03/28/2015] [Indexed: 12/19/2022] Open
Abstract
Neoadjuvant systemic therapy (NAST) provides the unique opportunity to assess response to treatment after months rather than years of follow-up. However, significant variability exists in methods of pathologic assessment of response to NAST, and thus its interpretation for subsequent clinical decisions. Our international multidisciplinary working group was convened by the Breast International Group-North American Breast Cancer Group (BIG-NABCG) collaboration and tasked to recommend practical methods for standardized evaluation of the post-NAST surgical breast cancer specimen for clinical trials that promote accurate and reliable designation of pathologic complete response (pCR) and meaningful characterization of residual disease. Recommendations include multidisciplinary communication; clinical marking of the tumor site (clips); and radiologic, photographic, or pictorial imaging of the sliced specimen, to map the tissue sections and reconcile macroscopic and microscopic findings. The information required to define pCR (ypT0/is ypN0 or ypT0 yp N0), residual ypT and ypN stage using the current AJCC/UICC system, and the Residual Cancer Burden system were recommended for quantification of residual disease in clinical trials.
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Affiliation(s)
- V Bossuyt
- Department of Pathology, Yale University, New Haven, USA
| | - E Provenzano
- Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - W F Symmans
- Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston
| | - J C Boughey
- Division of Subspecialty General Surgery, Mayo Clinic, Rochester, USA
| | - C Coles
- Oncology Centre, Cambridge University Hospitals National Health Services Foundation Trust, Cambridge, UK
| | - G Curigliano
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology, Milan, Italy
| | - J M Dixon
- Edinburgh Breast Unit, Western General Hospital, Edinburgh, UK
| | - L J Esserman
- Carol Franc Buck Breast Care Center, University of California, San Francisco, USA
| | - G Fastner
- Department of Radiotherapy and Radiation Oncology, Landeskrankenhaus, Paracelsus Medical University, Salzburg, Austria
| | - T Kuehn
- Department of Gynecology and Obstetrics, Interdisciplinary Breast Center, Klinikum Esslingen, Essligen, Germany
| | - F Peintinger
- Institute of Pathology, Medical University of Graz, Graz Breast Center Salzburg, Paracelsus Medical University, University Hospital Salzburg, Salzburg, Austria
| | - G von Minckwitz
- German Breast Group, Neu-Isenburg, and University Women's Hospital, Frankfurt, Germany
| | - J White
- Department of Radiation Oncology, Ohio State University Comprehensive Cancer Center, Columbus
| | - W Yang
- Department of Diagnostic Radiology, The University of Texas M.D. Anderson Cancer Center, Houston
| | - S Badve
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, USA
| | - C Denkert
- Institute of Pathology, Charité Hospital, Campus Mitte, Berlin, Germany
| | - G MacGrogan
- Department of Biopathology, Institut Bergonié, Bordeaux
| | - F Penault-Llorca
- Centre Jean Perrin, Clermont-Ferrand, and Université d'Auvergne, France
| | - G Viale
- Department of Pathology, European Institute of Oncology and University of Milan, Milan, Italy
| | - D Cameron
- Edinburgh Cancer Research UK Centre, The University of Edinburgh, Edinburgh, UK
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18F-FLT PET/CT as an imaging tool for early prediction of pathological response in patients with locally advanced breast cancer treated with neoadjuvant chemotherapy: a pilot study. Eur J Nucl Med Mol Imaging 2015; 42:818-30. [DOI: 10.1007/s00259-015-2995-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 01/14/2015] [Indexed: 02/07/2023]
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40
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Mombelli S, Kwiatkowski F, Abrial C, Wang-Lopez Q, de Boissieu P, Garbar C, Bensussan A, Curé H. Prognostic factors in operable breast cancer treated with neoadjuvant chemotherapy: towards a quantification of residual disease. Oncology 2015; 88:261-72. [PMID: 25573741 DOI: 10.1159/000368557] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 09/17/2014] [Indexed: 11/19/2022]
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.
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Affiliation(s)
- Sarah Mombelli
- Department of Clinical Research, Jean Godinot Institute, Reims, France
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Miller M, Ottesen RA, Niland JC, Kruper L, Chen SL, Vito C. Tumor response ratio predicts overall survival in breast cancer patients treated with neoadjuvant chemotherapy. Ann Surg Oncol 2014; 21:3317-23. [PMID: 25059788 DOI: 10.1245/s10434-014-3922-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Indexed: 01/07/2023]
Abstract
BACKGROUND Neoadjuvant chemotherapy (NAC) is commonly used to treat locally advanced breast cancer. Pathologic complete response (pCR) predicts improved overall survival (OS); however, prognosis of patients with partial response remains unclear. We evaluated whether tumor response ratio (TRR) is a better predictor of OS than current staging methods. METHODS Using the National Comprehensive Cancer Network Breast Cancer Outcomes Database, we identified patients with stage I-III breast cancer who had NAC and pretreatment imaging at City of Hope (1997-2010). Patient demographics, tumor characteristics, and OS were analyzed. TRR was calculated as residual in-breast disease divided by size on pre-NAC imaging. Four TRR groups were stratified; TRR 0 (pCR), TRR > 0-0.4 (strong partial response, SPR), TRR > 0.4-1.0 (weak partial response, WPR), or TRR > 1.0 (tumor growth, TG). OS was estimated by the Kaplan-Meier method and tested by the log-rank test. Cox regression was performed to evaluate associations between OS and TRR in a multivariable analysis while controlling for potential confounders. RESULTS There were 218 eligible patients identified; 59 (27 %) had pCR, 61 (28 %) SPR, 72 (33 %) WPR, and 26 (12 %) TG. Five-year OS decreased continuously with increasing TRR:pCR (90 %), SPR (79 %), WPR (66 %), and TG (60 %). TRR was the only measure that significantly predicted OS (p = 0.0035); pathologic stage (p = 0.23) and pre-NAC clinical tumor stage (cT) (p = 0.87) were not significant. TRR continued to be statistically significant by multivariable analysis (p = 0.016). CONCLUSIONS TRR takes into account both pretreatment and residual disease and more accurately predicts OS than pathologic stage and pre-NAC cT. TRR may be useful to more accurately assess prognosis and OS in breast cancer patients undergoing NAC.
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Affiliation(s)
- Marian Miller
- Department of Surgical Oncology, City of Hope, Duarte, CA, USA
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