Prognostic value of initial clinical disease stage after achieving pathological complete response

Shaheenah Dawood, Kristine Broglio, Shu Wan Kau, Rabiul Islam, W. Fraser Symmans, Thomas A. Buchholz, Sean E. McGuire, Funda Meric-Bernstam, Massimo Cristofanilli, Gabriel N. Hortobágyi, Ana M. Gonzalez-Angulo*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

21 Scopus citations

Abstract

The aim of this retrospective study was to determine the prognostic impact of initial clinical stage in patients who achieved a pathological complete response (pCR) after receiving primary systemic chemotherapy (PST). Between 1977 and 2006, 489 patients who had achieved a pCR after receiving an anthracycline-based PST regimen were identified. Recurrence-free survival (RFS) and overall survival (OS) were estimated with the Kaplan-Meier product limit method and the differences between groups were compared using the log-rank statistic. Cox proportional hazards models were fit to determine the association of initial clinical stage with survival outcomes after adjusting for patient and tumor characteristics. The median age was 47 years. Twenty (4.1%) patients had stage I disease, 243 (49.7%) had stage II disease, 189 (38.7%) had stage III disease, and 37 (7.5%) had inflammatory breast cancer (IBC). At a median follow-up of 45 months, 59 (12%) patients had experienced disease recurrence. The 5-year RFS and OS rates for the whole cohort were 87.8% and 89.3%, respectively. Lower clinical stage at diagnosis was associated with statistically significant higher RFS and OS rates. In a multivariate model, patients with clinical stage IIIB/C disease and those with IBC had lower RFS rates than patients with clinical stage I/II/IIIA disease. In addition, patients with clinical stage IIIB/C disease and those with IBC had a greater hazard of death than patients with clinical stage I/II/IIIA disease. Overall, patients who achieved a pCR had a low rate of recurrence. However, higher clinical stage and IBC were associated with worse outcomes in breast cancer patients who achieved a pCR after PST.

Original languageEnglish (US)
Pages (from-to)6-15
Number of pages10
JournalOncologist
Volume13
Issue number1
DOIs
StatePublished - Jan 2008

Keywords

  • Breast cancer
  • Clinical stage
  • Pathological complete response
  • Prognosis

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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