Clinical and Therapeutic Factors Vary by Prognosis in Patients with Pathological Complete Response After Neoadjuvant Therapy for Breast Cancer

Abstract

Purpose

To determine clinical predictors of recurrence and metastasis in patients with pathological complete response (pCR) after neoadjuvant chemotherapy (NCT).

Methods

Patients treated with NCT who achieved pCR (n=285) were classified into three groups according to pre-NCT clinical stage (cStage): group I (IIa–IIb), group II (IIIa), and group III (IIIb–IIIc). Survival was analysed using the Kaplan–Meier method. The relationships between clinicopathological factors and recurrence were determined using Cox regression analysis.

Results

The median follow-up was 31 months. The 3-year disease-free survival and overall survival rates in groups I, II, and III were 92.7%, 87.8%, and 66.7% (P < 0.01) and 98.6%, 98.3%, and 90.6% (P=0.370), respectively. Lymph node status and tumour size were independent risk factors for recurrence and metastasis after NCT. In the human epidermal growth factor receptor 2-positive subgroup, advanced cStage and lymph node metastasis were associated with recurrence (P < 0.01). In the hormone receptor-positive subgroup, disease-free survival rates differed for cStages I–II compared to cStage III (P=0.049) and clinical node status 0–2 compared to clinical node status 3 (P=0.037).

Conclusion

Pre-NCT cStage predicted the prognosis of pCR for different breast cancer subtypes. Patients with advanced cStage, lymph node metastasis, and large tumour sizes had a higher risk of recurrence or metastasis.

Keywords:

• breast cancer
• HER2
• neoadjuvant chemotherapy
• pathological complete response
• prognosis

Data Sharing Statement

The datasets generated during and analysed during the current study are available from the corresponding author on reasonable request.

Ethics Approval

All procedures performed in this study complied with the ethical standards of the institution and/or the National Research Council, as well as the 1964 Declaration of Helsinki and its subsequent amendments or comparable ethical standards. The retrospective study design was approved by the Ethics Committee of Harbin Medical University Cancer Hospital.

Consent to Participate

Written informed consent was obtained from each patient.

Consent to Publication

The authors affirm that all research participants provided written consent for the publication of their data in this study.

Disclosure

All authors declare that they have no conflicts of interest.