Residual cancer burden in locally advanced breast cancer: a superior tool

[摘要] Objectives: Locally advanced breast cancer (LABC) poses a difficult clinical challenge with overall poor long term prognosis .The strength of association between tumor characteristics, treatment response and outcome is not well defined. In this study, we attempt at gaining further insight into LABC by reviewing tumor characteristics of patients treated with neoadjuvant chemotherapy , and studying their association with outcome. We calculate the residual cancer burden (RCB) scores obtained at surgery and attempt to study its correlation with Event Free Survival (EFS) and overall survival (OS). Methods: Patients diagnosed with primarily LABC were included. Pathological and clinical responses were determined. Pathology slides were reviewed . Result: Forty five patients were included. Stage IIB 9%, IIIA 29%, IIIB 51 % and IIIC 11%.Sixteen percent had inflammatory breast cancer (IBC). Pathological complete response( PcR ) was achieved in 22% of all patients. None of the patients with inflammatory breast cancer achieved pCR. Estrogen receptor negative ( ER -)/Progesterone receptor negative (PR-) tumors were more likely to achieve pCR than ER+/PR + tumors. Among Human Epidermal Growth Factor Receptor- 2 (HER2 neu) overexpressing tumprs, 17% achieved pCR compared to 25% in HER2 neu - tumors; only one patient had received trastuzumab. Residual Cancer Burden scores were calculated in 32 patients and ranged between 0 and 4.6.Conclusion: This study attempts at studying practical issues related to the classification and management of LABC and IBC. RCB, defined from routine pathologic materials, was easily quantifiable and appears to be a better predictor of outcome following neoadjuvant chemotherapy in LABC compared to pCR. Higher RCB scores were associated with lower EFS and lower rate of OS . A continuous quest for reliable predictive and correlative prognostic markers, as well as better surrogate endpoints for outcome is essential in order to advance our understanding of this disease entity and improve treatment outcome.

[学科分类] 肿瘤学