Locally Advanced Breast Cancer (LABC): Real-World Outcome of Patients From Cancer Institute, Chennai

Abstract

Purpose: There are sparse data on the outcome of patients with locally advanced breast cancer (LABC). This report is on the prognostic factors and long-term outcome from Cancer Institute, Chennai.

Methods: This is an analysis of untreated patients with LABC (stages IIIA-C) who were treated from January 2006 to December 2013.

Results: Of the 4,577 patients with breast cancer who were treated, 2,137 patients (47%) with LABC were included for analysis. The median follow-up was 75 months (range, 1-170 months), and 2.3% (n = 49) were lost to follow-up at 5 years. The initial treatment was neoadjuvant concurrent chemoradiation (NACR) (77%), neoadjuvant chemotherapy (15%), or others (8%). Patients with triple-negative breast cancer had a pathologic complete response (PCR) of 41%. The 10-year overall survival was for stage IIIA (65.1%), stage IIIB (41.2%), and stage IIIC (26.7%). Recurrence of cancer was observed in 27% of patients (local 13% and distant 87%). Multivariate analysis showed that patients with a tumor size > 10 cm (hazard ratio [HR], 2.19; 95% CI, 1.62 to 2.98; P = .001), hormone receptor negativity (HR, 1.45; 95% CI, 1.22 to 1.72; P = .001), treatment modality (neoadjuvant chemotherapy, HR, 0.56; 95% CI, 0.43 to 0.73; P = .001), lack of PCR (HR, 2.36; 95% CI, 1.85 to 3.02; P = .001), and the presence of lymphovascular invasion (HR, 1.97; 95% CI, 1.60 to 2.44; P = .001) had decreased overall survival.

Conclusion: NACR was feasible in inoperable LABC and gave satisfactory long-term survival. PCR was significantly higher in patients with triple-negative breast cancer. The tumor size > 10 cm was significantly associated with inferior survival. However, this report acknowledges the limitations inherent in experience of management of LABC from a single center.

FIG 1

OS of all patients. Kaplan-Meier curve showing the OS of 2,137 patients. Numbers within parentheses are events. OS, overall survival.

FIG 2

DFS of all patients. Kaplan-Meier curve showing the DFS of 2,137 patients. Numbers within parentheses are events. DFS, disease-free survival.

FIG 3

DFS according to stage. Kaplan-Meier curve showing the stagewise DFS. Numbers within parentheses are events. DFS, disease-free survival.

FIG 4

DFS and tumor size. Kaplan-Meier curve showing the DFS according to the tumor size. Numbers within parentheses are events. DFS, disease-free survival.

FIG 5

DFS of patients with TNBC. Kaplan-Meier curve showing the DFS of patients with TNBC. Numbers within parentheses are events. DFS, disease-free survival; TNBC, triple-negative breast cancer.

FIG 6

DFS comparing NACR and NAC. Kaplan-Meier curve comparing DFS of patients treated with NAC and neoadjuvant concurrent chemoradiation. Numbers within parentheses are events. DFS, disease-free survival; NAC, neoadjuvant chemotherapy; NACR, XXX.

FIG A1

OS comparing NACR and NAC. Kaplan-Meier curve comparing OS of patients treated with NAC and NACR. Numbers within parentheses are events. HR, hazard ratio; NAC, neoadjuvant chemotherapy; NACR, neoadjuvant concurrent chemoradiation; OS, overall survival.