Pathological complete response is not the best prognostic factor in patients with breast cancer treated by preoperative chemotherapy


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Abstract

Abstract 158.Aim of the study.Preoperative chemotherapy (pCHT) changes established prognostic markers. This study evaluated the prognostic value of pathological complete response (pCR) in comparison to other prognostic factors (PF) after a follow up of 6 years.Material and methods.One hundred and fifty-six patients with locally advanced breast cancer (clinically T2 or T3-tumors, M0) obtained pCHT with Epirubicin/Cyclophosphamid (3-4 cycles, 90/600 mg/m2 every 3 weeks).Results.Seventy seven percentage of patients showed a remission of greater than 50% (n = 120) and a pCR in 6.4% (n = 10). Breast conserving surgery was performed in 68% (n = 106) of patients. Metastasis was seen in 38.4% (n = 60) of patients but only in two of patients with pCR (p = 0.146). Significant prognostic factors for DFS (disease-free survival) were the clinically assessed tumor size before pCHT (p = 0.009), the clinical nodal status before pCHT (p = 0.041), grading (p = 0.005), the histological tumor size after pCHT (p = 0.001), the histological axillary lymph node status after pCHT (p = 0.001) and the clinical response of the tumor to pCHT (p = 0.032). Regarding OAS (overall survival) only the grading and the pathological lymph node status proved to be statistically significant. Occurrence of pathological complete response did not prove to be a statistically significant marker. Regarding DFS grading (p < 0.001, RR = 2.49), histological tumor size after pCHT (p < 0.001, RR = 2.49) and the histological lymph node status (p < 0.001, RR = 2.11) proved to be independent prognostic factors in multivariate regression analysis. Looking at OAS histological lymph node status (p = 0.008, RR = 1.79) as well as grading (p = 0.001, RR = 3.48) remained independent prognostic factors.Summary.The most important prognostic factors after 6 years of follow up are the pathological lymph node status and the grading. Occurrence of pathological complete response was no statistically significant prognostic factor. Kind of pCHT and number of cycles could be responsible for this finding.

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