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Impact of the Histologic Pattern of Residual Tumor After Neoadjuvant Chemotherapy on Recurrence and Survival in Stage I–III Breast Cancer

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Additional risk-stratification measures are needed in breast cancer patients with residual disease after neoadjuvant chemotherapy (NAC). We aimed to describe oncologic outcomes in a modern cohort treated with NAC, and evaluate the prognostic value of histologic pattern of residual tumor.

Patients and Methods

We included patients with stage I–III breast cancer treated with NAC and surgery from 2004 to 2014. Histologic pattern of residual tumor was evaluated by central pathology review when slides were available. Multivariable Cox regression was performed to evaluate factors associated with locoregional recurrence (LRR), recurrence-free survival (RFS), and overall survival (OS).

Results

Among 975 patients, median follow-up was 74.0 months and 10-year rates of LRR, RFS, and OS were 9.8%, 67.6% and 74.4%, respectively. Biologic subtype, pathologic node-positive disease, and pathologic complete response (pCR) were associated with outcomes. Among 666 (68.3%) patients with central pathology review, pattern of residual disease was not significantly associated with LRR. However, both scattered residual tumor and no/minimal response relative to a concentric pattern of response were significantly associated with inferior RFS (scattered: hazard ratio 2.0, p = 0.015; no/minimal response: hazard ratio 2.2, p = 0.021) and OS (scattered: hazard ratio 2.2, p = 0.026; no/minimal response: hazard ratio 2.5, p = 0.023). This finding was most prominent in patients with triple-negative breast cancer.

Conclusions

Patients with a scattered relative to concentric pattern of residual tumor after NAC had inferior RFS and OS, nearly as poor as those with no/minimal response. Histologic pattern of residual tumor may represent a novel prognostic measure, particularly in the triple-negative breast cancer population.

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Funding

Primary funding was provided by the Rob and Karen Hale Distinguished Chair in Surgical Oncology (to E.A.M.). Additional funding for the project was provided by the Pam Gelsomini Fellowship Fund (to A.L.).

Author information

Author notes

  1. Ricardo Pastorello MD

    Present address: Department of Pathology, Hospital Sirio Libanes, Sao Paulo, Brazil

Authors and Affiliations

  1. Division of Breast Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Alison Laws MD, Ricardo Pastorello MD, Samantha Grossmith BA, Claire King BS, Monica McGrath BS, Elizabeth A. Mittendorf MD, PhD & Tari King MD

  2. Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA

    Alison Laws MD, Ricardo Pastorello MD, Samantha Grossmith BA, Stuart J. Schnitt MD, PhD, Elizabeth A. Mittendorf MD, PhD & Tari King MD

  3. Harvard Medical School, Boston, MA, 02215, USA

    Alison Laws MD, Tanujit Dey PhD, Stuart J. Schnitt MD, PhD, Elizabeth A. Mittendorf MD, PhD & Tari King MD

  4. Department of Surgery, Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, USA

    Tanujit Dey PhD

  5. Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA

    Stuart J. Schnitt MD, PhD

Authors
  1. Alison Laws MD
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  8. Elizabeth A. Mittendorf MD, PhD
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Corresponding author

Correspondence to Tari King MD.

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Disclosures

T.A.K. reports speakers honoraria and advisory board participation for Exact Sciences (formerly Genomic Health) and global advisory board participation for Besins Healthcare. E.A.M. reports clinical trial funding from Roche/Genentech (via SU2C grant) and Gilead; compensated advisory board service for, and consulting fees from, Roche/Genentech, Merck, and Exact Sciences; compensated advisory board service for AstraZeneca; honoraria from Physicians’ Education Resource; and uncompensated service on the Board of Directors for the American Society of Clinical Oncology, the steering committees of Roche/Genentech, Bristol-Myers Squibb, and Eli Lilly, and uncompensated service as a Scientific Advisor for Susan G. Komen for the Cure Foundation.

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Prior presentation: A subset of this data was presented as a poster presentation at the ASCO Annual Meeting 2020: Laws A., Pastorello R.G., Choi J., Kantor O., Grossmith S., Schnitt S.J., Golshan M., Mittendorf E.A., King T.A. The impact of pattern of tumor response and other post-treatment histologic features on local recurrence in patients treated with neoadjuvant chemotherapy and breast conservation. J Clin Oncol. 2020;.38:15_suppl:581. doi: 10.1200/JCO.2020.38.15_suppl.581.

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Laws, A., Pastorello, R., Dey, T. et al. Impact of the Histologic Pattern of Residual Tumor After Neoadjuvant Chemotherapy on Recurrence and Survival in Stage I–III Breast Cancer. Ann Surg Oncol 29, 7726–7736 (2022). https://doi.org/10.1245/s10434-022-12054-6

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  • DOI: https://doi.org/10.1245/s10434-022-12054-6

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