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. 2010 Sep;17(9):2411-8.
doi: 10.1245/s10434-010-1008-1. Epub 2010 Apr 6.

The relevance of breast cancer subtypes in the outcome of neoadjuvant chemotherapy

M E Straver  1 , E J Th Rutgers, S Rodenhuis, S C Linn, C E Loo, J Wesseling, N S Russell, H S A Oldenburg, N Antonini, M T F D Vrancken Peeters
Affiliations

The relevance of breast cancer subtypes in the outcome of neoadjuvant chemotherapy

M E Straver et al. Ann Surg Oncol. 2010 Sep.

Abstract

Background: Breast cancer is increasingly considered a heterogeneous disease. The aim of this study was to assess the differences between histological and receptor-based subtypes in breast-conserving surgery and pathological complete response (pCR) after neoadjuvant chemotherapy.

Method: A consecutive series of 254 patients with operable breast cancer treated with neoadjuvant chemotherapy was analyzed. Tumors were classified according to their receptor status in estrogen receptor (ER)-positive tumors (HER2-negative), triple-negative tumors, and HER2-positive tumors. The type of surgery feasible prior to neoadjuvant chemotherapy was compared with the actual surgery performed.

Results: The overall increase in breast-conserving surgery was 37% (73 of 198). In patients with ductal and lobular carcinomas this increase was 41% (63 of 152, 95% confidence interval [95% CI] 0.34-0.49) and 20% (7 of 35, 95% CI 0.10-0.36), respectively (P = 0.02). Half of the patients with lobular carcinoma had to undergo a secondary mastectomy because of incomplete resection margins. In ER-positive, triple-negative and HER2-positive tumors, the increase in breast-conserving surgery was 39% (42 of 109, 95% CI 0.30-0.48), 24% (11 of 45, 95% CI 0.14-0.38), and 45% (20 of 44, 95% CI 0.32-0.60) (P = 0.11). The pCR rate in ductal and lobular carcinomas was 12% (23 of 195) and 2% (1 of 42), respectively (P = 0.09). In ER-positive, triple-negative and HER2-positive tumors the pCR rates were 2% (3 of 138), 28% (16 of 57), and 18% (10 of 56), respectively. Multivariate analysis showed that the receptor-based subtype was the only significant predictor of pCR (P = 0.004).

Conclusion: In lobular tumors the benefit with regard to breast-conserving surgery of neoadjuvant chemotherapy is questionable. Although in ER-positive tumors the pCR rate is low, the increase in breast-conserving surgery was remarkable in ductal ER-positive tumors.

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Figures

Fig. 1
Fig. 1
Increase in breast-conserving surgery by histological subtype. The type of surgery feasible prior to neoadjuvant chemotherapy is compared with the actual surgery performed after neoadjuvant chemotherapy. The increase in breast-conserving surgery (shown in the blue boxes) is higher in ductal carcinomas. NAC, neoadjuvant chemotherapy; BCS, breast-conserving surgery
Fig. 2
Fig. 2
Increase in breast-conserving surgery by receptor-based subtype. The type of surgery feasible prior to neoadjuvant chemotherapy is compared with the actual surgery performed after neoadjuvant chemotherapy. The increase in breast-conserving surgery (shown in the blue boxes) is highest in HER2-positive carcinomas. NAC, neoadjuvant chemotherapy; BCS, breast conserving surgery
See this image and copyright information in PMC

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