Locoregional Control According to Breast Cancer Subtype and Response to Neoadjuvant Chemotherapy in Breast Cancer Patients Undergoing Breast-conserving Therapy

Shannon K. Swisher, Jose Vila, Susan L. Tucker, Isabelle Bedrosian, Simona F. Shaitelman, Jennifer K. Litton, Benjamin D. Smith, Abigail S. Caudle, Henry M. Kuerer, Elizabeth A. Mittendorf

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Abstract

Background: Our group previously published data showing that patients could be stratified by constructed molecular subtype with respect to locoregional recurrence (LRR)-free survival after neoadjuvant chemotherapy and breast-conserving therapy (BCT). That study predated use of trastuzumab for human epidermal growth factor receptor 2 (HER2)-positive patients. The current study was undertaken to determine the impact of subtype and response to therapy in a contemporary cohort. Methods: Clinicopathologic data from 751 breast cancer patients who received neoadjuvant chemotherapy (with trastuzumab if HER2+) and BCT from 2005 to 2012 were identified. Hormone receptor (HR) and HER2 status were used to construct molecular subtypes: HR+/HER2 (n = 369), HR+/HER2+ (n = 105), HR/HER2+ (n = 58), and HR/HER2 (n = 219). Actuarial rates of LRR were determined by the Kaplan–Meier method and compared by the log-rank test. Multivariate analysis was performed to determine factors associated with LRR. Results: The pathologic complete response (pCR) rates by subtype were as follows: 16.5 % (HR+/HER2), 45.7 % (HR+/HER2+), 72.4 % (HR/HER2+), and 42.0 % (HR/HER2) (P < 0.001). Median follow-up was 4.6 years. The 5-year LRR-free survival rate for all patients was 95.4 %. Five-year LRR-free survival rates by subtype were 97.2 % (HR+/HER2), 96.1 % (HR+/HER2+), 94.4 % (HR/HER2+), and 93.4 % (HR/HER2) (P = 0.44). For patients with HR/HER2+ disease, the LRR-free survival rates were 97.4 and 86.7 % for those who did and those who did not experience pCR, respectively. For patients with HR/HER2 disease, the LRR-free survival rates were 98.6 % (pCR) versus 89.9 % (no pCR). On multivariate analysis, the HR/HER2 subtype, clinical stage III disease, and failure to experience a pCR were associated with LRR. Conclusions: Patients undergoing BCT after neoadjuvant chemotherapy have excellent rates of 5-year LRR-free survival that are affected by molecular subtype and by response to neoadjuvant chemotherapy.

Original languageEnglish
Pages (from-to)749-756
Number of pages8
JournalAnnals of Surgical Oncology
Volume23
Issue number3
DOIs
Publication statusPublished - Mar 1 2016

ASJC Scopus subject areas

  • Surgery
  • Oncology

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    Swisher, S. K., Vila, J., Tucker, S. L., Bedrosian, I., Shaitelman, S. F., Litton, J. K., Smith, B. D., Caudle, A. S., Kuerer, H. M., & Mittendorf, E. A. (2016). Locoregional Control According to Breast Cancer Subtype and Response to Neoadjuvant Chemotherapy in Breast Cancer Patients Undergoing Breast-conserving Therapy. Annals of Surgical Oncology, 23(3), 749-756. https://doi.org/10.1245/s10434-015-4921-5