Tumor biology correlates with rates of breast-conserving surgery and pathologic complete response after neoadjuvant chemotherapy for breast cancer: findings from the ACOSOG Z1071 (Alliance) Prospective Multicenter Clinical Trial.

Abstract

OBJECTIVE:

To determine the impact of tumor biology on rates of breast-conserving surgery and pathologic complete response (pCR) after neoadjuvant chemotherapy.

BACKGROUND:

The impact of tumor biology on the rate of breast-conserving surgery after neoadjuvant chemotherapy has not been well studied.

METHODS:

We used data from ACOSOG Z1071, a prospective, multicenter study assessing sentinel lymph node surgery after neoadjuvant chemotherapy in patients presenting with node-positive breast cancer from 2009 through 2011, to determine rates of breast-conserving surgery and pCR after chemotherapy by approximated biologic subtype.

RESULTS:

Of the 756 patients enrolled on Z1071, 694 had findings available from pathologic review of breast and axillary specimens from surgery after chemotherapy. Approximated subtype was triple-negative in 170 (24.5%), human epidermal growth factor receptor 2 (HER2)-positive in 207 (29.8%), and hormone-receptor-positive, HER2-negative in 317 (45.7%) patients. Patient age, clinical tumor and nodal stage at presentation did not differ across subtypes. Rates of breast-conserving surgery were significantly higher in patients with triple-negative (46.8%) and HER2-positive tumors (43.0%) than in those with hormone-receptor-positive, HER2-negative tumors (34.5%) (P = 0.019). Rates of pCR in both the breast and axilla were 38.2% in triple-negative, 45.4% in HER2-positive, and 11.4% in hormone-receptor-positive, HER2-negative disease (P < 0.0001). Rates of pCR in the breast only and the axilla only exhibited similar differences across tumor subtypes.

CONCLUSIONS:

Patients with triple-negative and HER2-positive breast cancers have the highest rates of breast-conserving surgery and pCR after neoadjuvant chemotherapy. Patients with these subtypes are most likely to be candidates for less invasive surgical approaches after chemotherapy.

• Authors: Judy C Boughey, Linda M McCall, Karla V Ballman, Elizabeth A Mittendorf, Gretchen M Ahrendt, Lee G Wilke, Bret Taback, A Marilyn Leitch, Teresa Flippo-Morton, Kelly K Hunt
• Journal: Annals of surgery (Ann Surg) Vol. 260 Issue 4 Pg. 608-14; discussion 614-6 (Oct 2014) ISSN: 1528-1140 [Electronic] United States
• PMID: 25203877 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• ERBB2 protein, human
• Receptor, ErbB-2

Topics

• Axilla (pathology)
• Breast Neoplasms (drug therapy, pathology, surgery)
• Chemotherapy, Adjuvant
• Female
• Humans
• Lymph Node Excision
• Lymph Nodes (pathology)
• Lymphatic Metastasis
• Mastectomy, Segmental (statistics & numerical data)
• Neoadjuvant Therapy
• Neoplasm Staging
• Prospective Studies
• Receptor, ErbB-2 (analysis)