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The Clinical Significance of Breast-only and Node-only Pathologic Complete Response (pCR) After Neoadjuvant Chemotherapy (NACT): A Review of 20,000 Breast Cancer Patients in the National Cancer Data Base (NCDB).

Publication ,  Journal Article
Fayanju, OM; Ren, Y; Thomas, SM; Greenup, RA; Plichta, JK; Rosenberger, LH; Tamirisa, N; Force, J; Boughey, JC; Hyslop, T; Hwang, ES
Published in: Ann Surg
October 2018

OBJECTIVE: To determine whether the association between overall survival (OS) and response to neoadjuvant chemotherapy (NACT) in breast cancer patients varies with tumor subtype and anatomic extent of pathologic complete response (pCR). BACKGROUND: pCR after NACT predicts improved OS in breast cancer, but it is unclear whether pCR limited to the breast or axilla is also associated with OS. METHODS: Women with cT1-3/cN0-1 breast cancer diagnosed in 2010 to 2014 who underwent surgery following NACT were identified in the NCDB and divided into 4 subtypes based on reported hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status. Kaplan-Meier curves and Cox proportional hazards models were used to estimate OS. Multivariate logistic regression was used to identify factors associated with post-NACT response, defined as upstage (yp stage>clinical stage); no change (clinical stage = yp stage); overall (breast+axilla, ypT0N0), breast-only (ypT0N1/N1mic), or node-only (ypT1-3N0) pCR. RESULTS: Of 33,162 identified patients, 20,265 experienced overall pCR (n = 6370, 19.2%), breast-only pCR (n = 494, 1.5%), node-only pCR (n = 1133, 3.4%), no stage change (n = 9641, 29.1%), or upstage (n = 2627, 7.9%). Compared with no stage change, breast-only pCR was associated with improved OS in triple-negative disease [hazard ratio = 0.58, 95% confidence interval (95% CI) = 0.37-0.89], and node-only pCR was associated with improved OS in both triple-negative (hazard ratio = 0.55,95% CI = 0.39-0.76) and HR+/HER2- disease (hazard ratio = 0.54, 95% CI = 0.33-0.89). For patients achieving overall (breast+axilla) pCR, unadjusted 5-year OS was 0.94 (95% CI = 0.93-0.95), with no difference between patients who were cN0 (hazard ratio = 0.95, 95% CI = 0.93-0.96) or cN1 (hazard ratio = 0.94, 95% CI = 0.92-0.96) at diagnosis. CONCLUSIONS: In node-positive patients, pCR limited to either the breast or axilla predicts survival for select receptor subtypes. In patients achieving pCR in both the breast and axilla, survival is driven by response to NACT rather than presenting cN stage.

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Published In

Ann Surg

DOI

EISSN

1528-1140

Publication Date

October 2018

Volume

268

Issue

4

Start / End Page

591 / 601

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Survival Analysis
  • Surgery
  • Neoplasm, Residual
  • Neoplasm Staging
  • Neoadjuvant Therapy
  • Middle Aged
  • Lymphatic Metastasis
  • Lymph Node Excision
 

Citation

APA
Chicago
ICMJE
MLA
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Fayanju, O. M., Ren, Y., Thomas, S. M., Greenup, R. A., Plichta, J. K., Rosenberger, L. H., … Hwang, E. S. (2018). The Clinical Significance of Breast-only and Node-only Pathologic Complete Response (pCR) After Neoadjuvant Chemotherapy (NACT): A Review of 20,000 Breast Cancer Patients in the National Cancer Data Base (NCDB). Ann Surg, 268(4), 591–601. https://doi.org/10.1097/SLA.0000000000002953
Fayanju, Oluwadamilola M., Yi Ren, Samantha M. Thomas, Rachel A. Greenup, Jennifer K. Plichta, Laura H. Rosenberger, Nina Tamirisa, et al. “The Clinical Significance of Breast-only and Node-only Pathologic Complete Response (pCR) After Neoadjuvant Chemotherapy (NACT): A Review of 20,000 Breast Cancer Patients in the National Cancer Data Base (NCDB).Ann Surg 268, no. 4 (October 2018): 591–601. https://doi.org/10.1097/SLA.0000000000002953.
Fayanju OM, Ren Y, Thomas SM, Greenup RA, Plichta JK, Rosenberger LH, Tamirisa N, Force J, Boughey JC, Hyslop T, Hwang ES. The Clinical Significance of Breast-only and Node-only Pathologic Complete Response (pCR) After Neoadjuvant Chemotherapy (NACT): A Review of 20,000 Breast Cancer Patients in the National Cancer Data Base (NCDB). Ann Surg. 2018 Oct;268(4):591–601.

Published In

Ann Surg

DOI

EISSN

1528-1140

Publication Date

October 2018

Volume

268

Issue

4

Start / End Page

591 / 601

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Survival Analysis
  • Surgery
  • Neoplasm, Residual
  • Neoplasm Staging
  • Neoadjuvant Therapy
  • Middle Aged
  • Lymphatic Metastasis
  • Lymph Node Excision