Clinicopathological predictors of long-term benefit in breast cancer treated with neoadjuvant chemotherapy
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Fecha
2018Autor(es)
Castaneda, Carlos A
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AIM
To investigate the survival impact of clinicopathological
factors, including pathological complete response
(pCR) and tumor-infiltrating lymphocytes (sTIL) levels
according to subtypes, in breast cancer (BC) patients
who received neo-adjuvant chemotherapy (NAC).
METHODS
We evaluated 435 BC patients who presented and
received NAC at the Instituto Nacional de Enfermedades
Neoplasicas from 2003 to 2014. sTIL was analyzed
as the proportion of tumor stroma occupied by
lymphocytes, and was prospectively evaluated on
hematoxylin and eosin-stained sections of the preNAC
core biopsy. pCR was considered in the absence of
infiltrating cancer cells in primary tumor and axillary
lymph nodes. Analysis of statistical association between
clinical pathological features, sTIL, pCR and survival
were carried out using SPSSvs19.
RESULTS
Median age was 49 years (range 24-84 years) and the
most frequent clinical stage was III B (58.3%). Luminal
A, Luminal B, HER2-enriched and (triple-negative) TN
phenotype was found in 24.6%, 37.9%, 17.7% and
19.8%, respectively. pCR was observed in 11% and
median percentage of sTIL was 40% (2%-95%) in
the whole population. pCR was associated to Ct1-2
( P = 0.045) and to high sTIL ( P = 0.029) in the
whole population. There was a slight trend towards
significance for sTIL ( P = 0.054) in Luminal A. sTIL
was associated with grade III ( P < 0.001), no-Luminal
A subtype ( P < 0.001), RE-negative ( P < 0.001), PgR-
negative ( P < 0.001), HER2-positive ( P = 0.002) and
pCR ( P = 0.029) in the whole population. Longer
disease-free survival was associated with grade I - II ( P
= 0.006), cN0 ( P < 0.001), clinical stage II ( P = 0.004),
ER-positive ( P < 0.001), PgR-positive ( P < 0.001),
luminal A ( P < 0.001) and pCR ( P = 0.002). Longer
disease-free survival was associated with grade I - II in
Luminal A ( P < 0.001), N0-1 in Luminal A ( P = 0.045)
and TNBC ( P = 0.01), clinical stage II in Luminal A ( P
= 0.003) and TNBC ( P = 0.038), and pCR in TNBC ( P
< 0.001). Longer overall survival was associated with
grade I - II ( P < 0.001), ER-positive ( P < 0.001), PgR-
positive ( P < 0.001), Luminal A ( P < 0.001), cN0 ( P =
0.002) and pCR ( P = 0.002) in the whole population.
Overall survival was associated with clinical stage II ( P
= 0.017) in Luminal A, older age ( P = 0.042) in Luminal
B, and pCR in TNBC ( P = 0.005).
CONCLUSION
Predictive and prognostic values of clinicopathological
features, like pCR and sTIL, differ depending on the
evaluated molecular subtype.
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