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. 2024 Jun 30;16(13):2421.
doi: 10.3390/cancers16132421.

Breast Cancer Patient's Outcomes after Neoadjuvant Chemotherapy and Surgery at 5 and 10 Years for Stage II-III Disease

Catalina Falo  1   2 , Juan Azcarate  3 , Sergi Fernandez-Gonzalez  2   4 , Xavier Perez  5 , Ana Petit  2   3 , Héctor Perez  2   6 , Andrea Vethencourt  1   2 , Silvia Vazquez  1   2 , Maria Laplana  2   6 , Miriam Ales  1 , Agostina Stradella  1   2 , Bartomeu Fullana  1   2 , Maria J Pla  2   3 , Anna Gumà  2   7 , Raul Ortega  2   7 , Mar Varela  2   3 , Diana Pérez  8 , Jose Luis Ponton  5 , Sara Cobo  9 , Ana Benitez  10 , Miriam Campos  4 , Adela Fernández  1   2 , Rafael Villanueva  1   2 , Veronica Obadia  1   2 , Sabela Recalde  1   2 , Teresa Soler-Monsó  3 , Ana Lopez-Ojeda  8 , Evelyn Martinez  2   6 , Jordi Ponce  2   4 , Sonia Pernas  1   2 , Miguel Gil-Gil  1   2 , Amparo Garcia-Tejedor  2   3
Affiliations

Breast Cancer Patient's Outcomes after Neoadjuvant Chemotherapy and Surgery at 5 and 10 Years for Stage II-III Disease

Catalina Falo et al. Cancers (Basel). .

Abstract

Introduction: Neoadjuvant chemotherapy in breast cancer offers the possibility to facilitate breast and axillary surgery; it is a test of chemosensibility in vivo with significant prognostic value and may be used to tailor adjuvant treatment according to the response. Material and Methods: A retrospective single-institution cohort of 482 stage II and III breast cancer patients treated with neoadjuvant chemotherapy based on anthracycline and taxans, plus antiHEr2 in Her2-positive cases, was studied. Survival was calculated at 5 and 10 years. Kaplan-Meier curves with a log-rank test were calculated for differences according to age, BRCA status, menopausal status, TNM, pathological and molecular surrogate subtype, 20% TIL cut-off, surgical procedure, response to chemotherapy and the presence of vascular invasion. Results: The pCR rate was 25.3% and was greater in HER2 (51.3%) and TNBC (31.7%) and in BRCA carriers (41.9%). The factors independently related to patient survival were pathology and molecular surrogate subtype, type of surgery, response to NACT and vascular invasion. BRCA status was a protective prognostic factor without reaching statistical significance, with an HR 0.5 (95%CI 0.1-1.4). Mastectomy presented a double risk of distant recurrence compared to breast-conservative surgery (BCS), supporting BCS as a safe option after NACT. After a mean follow-up of 126 (SD 43) months, luminal tumors presented a substantial difference in survival rates calculated at 5 or 10 years (81.2% compared to 74.7%), whereas that for TNBC was 75.3 and 73.5, respectively. The greatest difference was seen according to the response in patients with pCR, who exhibited a 10 years DDFS of 95.5% vs. 72.4% for those patients without pCR, p < 0001. This difference was especially meaningful in TNBC: the 10 years DDFS according to an RCB of 0 to 3 was 100%, 80.6%, 69% and 49.2%, respectively, p < 0001. Patients with a particularly poor prognosis were those with lobular carcinomas, with a 10 years DDFS of 42.9% vs. 79.7% for ductal carcinomas, p = 0.001, and patients with vascular invasion at the surgical specimen, with a 10 years DDFS of 59.2% vs. 83.6% for those patients without vascular invasion, p < 0.001. Remarkably, BRCA carriers presented a longer survival, with an estimated 10 years DDFS of 89.6% vs. 77.2% for non-carriers, p = 0.054. Conclusions: Long-term outcomes after neoadjuvant chemotherapy can help patients and clinicians make well-informed decisions.

Keywords: breast cancer; neoadjuvant chemotherapy; prognostic factors; survival; well-informed decision making.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
DFS, DDFS, BCSS and OS. Kaplan–Meier curves: (A) Disease-free survival (DFS). (B) Distant disease-free survival (DDFS). (C) Breast-cancer-specific survival (BCSS). (D) Overall survival (OS).
Figure 1
Figure 1
DFS, DDFS, BCSS and OS. Kaplan–Meier curves: (A) Disease-free survival (DFS). (B) Distant disease-free survival (DDFS). (C) Breast-cancer-specific survival (BCSS). (D) Overall survival (OS).
Figure 2
Figure 2
Kaplan–Meier curves for distant disease-free survival according to basal patient and tumor characteristics: age cut-off of 40, BRCA status, anatomic TNM, pathology subtype, molecular surrogate subtype and TILs at a 20% cut-off. Kaplan–Meier curves for distant disease-free survival (DDFS): (A) Age cut-off 40. (B) BRCA carriers. (C) Anatomic TNM. (D) Pathology subtype. (E) Molecular surrogate subtype. (F) TIL cut-off of 20%.
Figure 2
Figure 2
Kaplan–Meier curves for distant disease-free survival according to basal patient and tumor characteristics: age cut-off of 40, BRCA status, anatomic TNM, pathology subtype, molecular surrogate subtype and TILs at a 20% cut-off. Kaplan–Meier curves for distant disease-free survival (DDFS): (A) Age cut-off 40. (B) BRCA carriers. (C) Anatomic TNM. (D) Pathology subtype. (E) Molecular surrogate subtype. (F) TIL cut-off of 20%.
Figure 3
Figure 3
Kaplan–Meier curves according to surgical approach and pathological findings. Kaplan–Meier curves for distant disease-free survival (DDFS): (A) Breast surgery. (B) Pathologic complete response (pCR). (C) Residual cancer burden (RCB). (D) Vascular invasion.
Figure 3
Figure 3
Kaplan–Meier curves according to surgical approach and pathological findings. Kaplan–Meier curves for distant disease-free survival (DDFS): (A) Breast surgery. (B) Pathologic complete response (pCR). (C) Residual cancer burden (RCB). (D) Vascular invasion.
Figure 4
Figure 4
Kaplan–Meier curves according to RCB in each molecular surrogate subtype. Kaplan–Meier curves for distant disease-free survival (DDFS): (A) Luminal A-like. (B) Luminal B-like. (C) Luminal B HER2. (D) HER2. (E) Triple-negative breast cancer (TNBC).
Figure 4
Figure 4
Kaplan–Meier curves according to RCB in each molecular surrogate subtype. Kaplan–Meier curves for distant disease-free survival (DDFS): (A) Luminal A-like. (B) Luminal B-like. (C) Luminal B HER2. (D) HER2. (E) Triple-negative breast cancer (TNBC).
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