Clinical course of breast cancer patients with complete pathologic primary tumor and axillary lymph node response to doxorubicin-based neoadjuvant chemotherapy. Academic Article uri icon

Overview

abstract

  • PURPOSE: To assess patient and tumor characteristics associated with a complete pathologic response (pCR) in both the breast and axillary lymph node specimens and the outcome of patients found to have a pCR after neoadjuvant chemotherapy for locally advanced breast cancer (LABC). PATIENTS AND METHODS: Three hundred seventy-two LABC patients received treatment in two prospective neoadjuvant trials using four cycles of doxorubicin-containing chemotherapy. Patients had a total mastectomy with axillary dissection or segmental mastectomy and axillary dissection followed by four or more cycles of additional chemotherapy. Patients then received irradiation treatment of the chest-wall or breast and regional lymphatics. Median follow-up was 58 months (range, 8 to 99 months). RESULTS: The initial nodal status, age, and stage distribution of patients with a pCR were not significantly different from those of patients with less than a pCR (P>.05). Patients with a pCR had initial tumors that were more likely to be estrogen receptor (ER)-negative (P<.01), and anaplastic (P = .01) but of smaller size (P<.01) than those of patients with less than a pCR. Upon multivariate analysis, the effects of ER status and nuclear grade were independent of initial tumor size. Sixteen percent of the patients in this study (n = 60) had a pathologic complete primary tumor response. Twelve percent of patients (n = 43) had no microscopic evidence of invasive cancer in their breast and axillary specimens. A pathologic complete primary tumor response was predictive of a complete axillary lymph node response (P<.01 ). The 5-year overall and disease-free survival rates were significantly higher in the group who had a pCR (89% and 87%, respectively) than in the group who had less than a pCR (64% and 58%, respectively; P<.01). CONCLUSION: Neoadjuvant chemotherapy has the capacity to completely clear the breast and axillary lymph nodes of invasive tumor before surgery. Patients with LABC who have a pCR in the breast and axillary nodes have a significantly improved disease-free survival rate. However, a pCR does not entirely eliminate recurrence. Further efforts should focus on elucidating the molecular mechanisms associated with this response.

authors

  • Kuerer, H M
  • Newman, Lisa
  • Smith, T L
  • Ames, F C
  • Hunt, K K
  • Dhingra, Kapil
  • Theriault, R L
  • Singh, Gurpreet
  • Binkley, S M
  • Sneige, Nour
  • Buchholz, T A
  • Ross, M I
  • McNeese, M D
  • Buzdar, A U
  • Hortobagyi, G N
  • Singletary, S E

publication date

  • February 1, 1999

Research

keywords

  • Antineoplastic Combined Chemotherapy Protocols
  • Breast Neoplasms
  • Lymph Nodes

Identity

Scopus Document Identifier

  • 0033050164

Digital Object Identifier (DOI)

  • 10.1200/JCO.1999.17.2.460

PubMed ID

  • 10080586

Additional Document Info

volume

  • 17

issue

  • 2