Breast Cancer Patient's Outcomes after Neoadjuvant Chemotherapy and Surgery at 5 and 10 Years for Stage II-III Disease

• Published in: Cancers 2024-06, Vol.16 (13), p.2421
• Main Authors: Falo, Catalina, Azcarate, Juan, Fernandez-Gonzalez, Sergi, Perez, Xavier, Petit, Ana, Perez, Héctor, Vethencourt, Andrea, Vazquez, Silvia, Laplana, Maria, Ales, Miriam, Stradella, Agostina, Fullana, Bartomeu, Pla, Maria J, Gumà, Anna, Ortega, Raul, Varela, Mar, Pérez, Diana, Ponton, Jose Luis, Cobo, Sara, Benitez, Ana, Campos, Miriam, Fernández, Adela, Villanueva, Rafael, Obadia, Veronica, Recalde, Sabela, Soler-Monsó, Teresa, Lopez-Ojeda, Ana, Martinez, Evelyn, Ponce, Jordi, Pernas, Sonia, Gil-Gil, Miguel, Garcia-Tejedor, Amparo
• Format: Article
• Language: English
• Subjects: Anthracycline; Breast cancer; Cancer therapies; Carcinoma; Chemotherapy; Clinical trials; ErbB-2 protein; Gene amplification; Mastectomy; Medical prognosis; Oncology; Pathology; Patients; Surgery; Surgical outcomes; Survival; Tumors
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers16132421

: Neoadjuvant chemotherapy in breast cancer offers the possibility to facilitate breast and axillary surgery; it is a test of chemosensibility in vivo with significant prognostic value and may be used to tailor adjuvant treatment according to the response. : A retrospective single-institution cohort of 482 stage II and III breast cancer patients treated with neoadjuvant chemotherapy based on anthracycline and taxans, plus antiHEr2 in Her2-positive cases, was studied. Survival was calculated at 5 and 10 years. Kaplan-Meier curves with a log-rank test were calculated for differences according to age, BRCA status, menopausal status, TNM, pathological and molecular surrogate subtype, 20% TIL cut-off, surgical procedure, response to chemotherapy and the presence of vascular invasion. : The pCR rate was 25.3% and was greater in HER2 (51.3%) and TNBC (31.7%) and in BRCA carriers (41.9%). The factors independently related to patient survival were pathology and molecular surrogate subtype, type of surgery, response to NACT and vascular invasion. BRCA status was a protective prognostic factor without reaching statistical significance, with an HR 0.5 (95%CI 0.1-1.4). Mastectomy presented a double risk of distant recurrence compared to breast-conservative surgery (BCS), supporting BCS as a safe option after NACT. After a mean follow-up of 126 (SD 43) months, luminal tumors presented a substantial difference in survival rates calculated at 5 or 10 years (81.2% compared to 74.7%), whereas that for TNBC was 75.3 and 73.5, respectively. The greatest difference was seen according to the response in patients with pCR, who exhibited a 10 years DDFS of 95.5% vs. 72.4% for those patients without pCR, < 0001. This difference was especially meaningful in TNBC: the 10 years DDFS according to an RCB of 0 to 3 was 100%, 80.6%, 69% and 49.2%, respectively, < 0001. Patients with a particularly poor prognosis were those with lobular carcinomas, with a 10 years DDFS of 42.9% vs. 79.7% for ductal carcinomas, = 0.001, and patients with vascular invasion at the surgical specimen, with a 10 years DDFS of 59.2% vs. 83.6% for those patients without vascular invasion, < 0.001. Remarkably, BRCA carriers presented a longer survival, with an estimated 10 years DDFS of 89.6% vs. 77.2% for non-carriers, = 0.054. : Long-term outcomes after neoadjuvant chemotherapy can help patients and clinicians make well-informed decisions.