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. 2022 Dec 1:12:1016295.
doi: 10.3389/fonc.2022.1016295. eCollection 2022.

Predictive factors for relapse in triple-negative breast cancer patients without pathological complete response after neoadjuvant chemotherapy

Angela Toss  1   2 , Marta Venturelli  1 , Monica Civallero  3 , Claudia Piombino  1 , Federica Domati  2 , Guido Ficarra  4 , Francesca Combi  5   6 , Eleonora Cabitza  1 , Federica Caggia  1 , Elena Barbieri  1 , Monica Barbolini  1 , Luca Moscetti  1 , Claudia Omarini  1 , Federico Piacentini  1   2 , Giovanni Tazzioli  2   5 , Massimo Dominici  1   2 , Laura Cortesi  1
Affiliations

Predictive factors for relapse in triple-negative breast cancer patients without pathological complete response after neoadjuvant chemotherapy

Angela Toss et al. Front Oncol. .

Abstract

Introduction: Triple-negative breast cancer (TNBC) patients who do not obtain pathological complete response (pCR) after neoadjuvant chemotherapy (NACT) present higher rate of relapse and worse overall survival. Risk factors for relapse in this subset of patients are poorly characterized. This study aimed to identify the predictive factors for relapse in TNBC patients without pCR after NACT.

Methods: Women with TNBC treated with NACT from January 2008 to May 2020 at the Modena Cancer Center were included in the analysis. In patients without pCR, univariate and multivariable Cox analyses were used to determine factors predictive of relapse.

Results: We identified 142 patients with a median follow-up of 55 months. After NACT, 62 patients obtained pCR (43.9%). Young age at diagnosis (<50 years) and high Ki-67 (20%) were signi!cantly associated with pCR. Lack of pCR after NACT resulted in worse 5-year event-free survival (EFS) and overall survival (OS). Factors independently predicting EFS in patients without pCR were the presence of multifocal disease [hazard ratio (HR), 3.77; 95% CI, 1.45-9.61; p=0.005] and residual cancer burden (RCB) III (HR, 3.04; 95% CI, 1.09-9.9; p=0.04). Neither germline BRCA status nor HER2-low expression were associated with relapse.

Discussion: These data can be used to stratify patients and potentially guide treatment decision-making, identifying appropriate candidates for treatment intensi!cation especially in neo-/adjuvant setting.

Keywords: multifocal disease; neoadjuvant chemotherapy; pathologic response; residual cancer burden (RCB); triple-negative breast cancer.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer EP declared a past co-editorship with one of the authors AT to the handling Editor.

Figures

Figure 1
Figure 1
EFS (A) and OS (B) according to pCR. Overall survival and presence or absence of relapse was compared between patients with and without pCR after NACT using the Kaplan–Meier method. Survival estimates were calculated and reported at 5 years, along with their 95% confidence intervals (95% CI), in pCR and no pCR group. (A) Patients who obtained pCR after NACT showed 5-year EFS 90% vs. 70%, p=0.008. Panel (B) represents 5-year OS in patients with and without pCR (95% vs. 69%, p=0.003).
Figure 2
Figure 2
EFS by (A) multifocal disease and (B) RCB in patients without pCR after neoadjuvant chemotherapy. Panel (A) presents EFS for patients not achieving pCR with and without multifocal disease (yes/no) and panel (B) presents EFS for patients with RCB II vs. RCB III.
See this image and copyright information in PMC

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