Prognostic Factors in Breast Cancer Patients Following Neoadjuvant Chemotherapy

ABSTRACT

PURPOSE: Axillary lymph node (ALN) status is the single most reliable indicator of the prognosis in early-stage breast cancer. However, downstaging of both the primary tumor and ALN involvement by neoadjuvant chemotherapy results in loss of traditional prognostic criteria. This study was performed to evaluate the prognostic significance of various clinicopathologic features in patients with operable breast cancer treated with neoadjuvant chemotherapy. METHODS: From Feb. 1991 to Oct. 1998, 73 patients with breast cancers (tumor size>3 cm, or clinically axillary node positive) were treated with preoperative combination chemotherapy comprised of preoperative 3 cycles and postoperative 3 cycles of FEC or MMM. The median follow-up period was 53 months. To analyze the potential simultaneous effect of the significant predictors of disease-free survival (DFS) and overall survival (OS) identified by univariate analysis, those factors were entered into a Cox multivariate regression model. RESULTS: Clinical responses to neoadjuvant chemotherapy were as follows, CR, 17.8% (13/73); PR, 57.5% (42/73); SD, 21.9% (16/73); and PD, 2.7% (2/72). The clinical response to neoadjuvant chemotherapy and the number of residual metastatic ALN were the only independent predictors of disease-free survival and overall survival. Patients with clinically complete response to neoadjuvant chemotherapy had a excellent 3-year DFS (100%) and 5-year OS (100%). In patients with a partial response, the number of metastatic ALN further stratified the patients with respect to DFS (p=0.003). Also, in patient with a stable disease, the number of metastatic ALN further stratified the patients with respect to DFS (p=0.000) and OS (p=0.000). Those with a progressive disease had a poor DFS and OS. CONCLUSION: Only the clinical response to neoadjuvant chemotherapy and the absolute number of metastatic ALN identified at surgical staging were the independent predictors of DFS and OS. Thus patients with partial or minor response can be further stratified with respect to DFS and OS by the number of involved ALNs.