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Prognostic significance of subtype and pathologic response in operable breast cancer; a pooled analysis of prospective neoadjuvant studies of JBCRG

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Abstract

Purpose

In the past decade, JBCRG has conducted three studies of neoadjuvant chemotherapy which have examined sequential combination of fluorouracil, epirubicin and cyclophosphamide, and docetaxel. The present study is a pooled analysis of these studies performed to determine the prognostic significance of pathologic complete response (pCR) and predictive variables for pCR.

Methods

A total of 353 patients were included. pCR was defined as the absence of invasive cancer or only a few remaining isolated cancer cells in the breast (quasi-pCR, QpCR).

Results

Disease-free survival (DFS) and overall survival (OS) were not significantly different among studies, and patients who achieved a QpCR had significantly better prognosis (DFS, p < 0.001; OS, p = 0.002). Patients with triple-negative (TN) tumors had worse prognosis than patients with the other subtypes (DFS, p = 0.03; OS, p = 0.10). A Cox proportional hazards model showed node-positive, TN, and QpCR were the significant predictors for DFS and OS among study, age, tumor size, nuclear grade, nodal status, subtype, clinical response, and pathologic response (DFS; node-positive, HR = 2.29, p = 0.001; TN, HR = 3.39, p < 0.001; QpCR, HR = 0.27, p < 0.001: OS; node-positive, HR = 3.05, p = 0.003; TN, HR = 4.92, p < 0.001; QpCR, HR = 0.12, p < 0.001). In a logistic regression analysis, subtype and clinical response before surgery were the significant predictive variables for QpCR (luminal/Her2-positive, odds ratio (OR) = 4.15, p = 0.002; Her2-positive, OR = 6.24, p < 0.001; TN, OR = 4.24, p < 0.001; clinical response before surgery, OR = 2.41, p = 0.019).

Conclusions

This study confirmed the prognostic significance of QpCR and nodal status and the predictive and prognostic significance of subtype in neoadjuvant chemotherapy.

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Acknowledgments

The JBCRG-01 study was supported by the Osaka Cancer Research Foundation and the Advanced Clinical Research Organization; JBCRG-02 and JBCRG-03 studies were supported by the Advanced Clinical Research Organization. The authors gratefully thank the patients who participated in the JBCRG-01, JBCRG-02, and JBCRG-03 studies. The authors also thank Mrs Kiyomi Kashiwa and Mrs Aya Maruyama for their support and data management.

Conflict of interest

The authors declare that they have no conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan

    Katsumasa Kuroi

  2. Department of Surgery (Breast Surgery), Graduate School of Medicine Kyoto University, Kyoto, Japan

    Masakazu Toi

  3. Department of Clinical Oncology, The Clinical Institute of NHO Kyusyu Cancer Center, Fukuoka, Japan

    Shinji Ohno

  4. Division of Breast Surgical Oncology, Department of Surgery, Showa University School of Medicine, Tokyo, Japan

    Seigo Nakamura

  5. Department of Breast Surgical Oncology, St. Luke’s International Hospital, Tokyo, Japan

    Seigo Nakamura

  6. Department of Breast Oncology, Aichi Cancer Center Hospital, Aichi, Japan

    Hiroji Iwata

  7. Department of Surgery, Breast Oncology, NHO Osaka National Hospital, Osaka, Japan

    Norikazu Masuda

  8. Department of Breast Oncology, Niigata Cancer Center Hospital, Niigata, Japan

    Nobuaki Sato

  9. Department of Basic Pathology, National Defense Medical College, Saitama, Japan

    Hitoshi Tsuda

  10. Department of Pathology, Saitama Cancer Center, Saitama, Japan

    Masafumi Kurosumi

  11. Department of Pathology, The Cancer Institute of Japanese Foundation for Cancer Research, Tokyo, Japan

    Futoshi Akiyama

  12. Department of Surgery, Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan

    Katsumasa Kuroi

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  1. Katsumasa Kuroi
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  2. Masakazu Toi
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Correspondence to Katsumasa Kuroi.

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Kuroi, K., Toi, M., Ohno, S. et al. Prognostic significance of subtype and pathologic response in operable breast cancer; a pooled analysis of prospective neoadjuvant studies of JBCRG. Breast Cancer 22, 486–495 (2015). https://doi.org/10.1007/s12282-013-0511-1

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  • DOI: https://doi.org/10.1007/s12282-013-0511-1

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