Clinical Course of Breast Cancer Patients With Complete Pathologic Primary Tumor and Axillary Lymph Node Response to Doxorubicin-Based Neoadjuvant Chemotherapy

作者：Henry M. Kuerer, Lisa A. Newman, Terry L. Smith, Fred C. Ames, Kelly K. Hunt, Kapil Dhingra, Richard L. Theriault, Gurpreet Singh, Susan M. Binkley, Nour Sneige, Thomas A. Buchholz, Merrick I. Ross, Marsha D. McNeese, Aman U. Buzdar, Gabriel N. Hortobágyi, S. Eva Singletary · 发表于：Journal of Clinical Oncology · 年份：1999 · DOI：10.1200/jco.1999.17.2.460 · 被引用次数：1342 · 研究领域：Breast Cancer Treatment Studies、Breast Lesions and Carcinomas、Multiple and Secondary Primary Cancers

PURPOSE: To assess patient and tumor characteristics associated with a complete pathologic response (pCR) in both the breast and axillary lymph node specimens and the outcome of patients found to have a pCR after neoadjuvant chemotherapy for locally advanced breast cancer (LABC). PATIENTS AND METHODS: Three hundred seventy-two LABC patients received treatment in two prospective neoadjuvant trials using four cycles of doxorubicin-containing chemotherapy. Patients had a total mastectomy with axillary dissection or segmental mastectomy and axillary dissection followed by four or more cycles of additional chemotherapy. Patients then received irradiation treatment of the chest-wall or breast and regional lymphatics. Median follow-up was 58 months (range, 8 to 99 months). RESULTS: The initial nodal status, age, and stage distribution of patients with a pCR were not significantly different from those of patients with less than a pCR (P>.05). Patients with a pCR had initial tumors that were more likely to be estrogen receptor (ER)-negative (P<.01), and anaplastic (P = .01) but of smaller size (P<.01) than those of patients with less than a pCR. Upon multivariate analysis, the effects of ER status and nuclear grade were independent of initial tumor size. Sixteen percent of the patients in this study (n = 60) had a pathologic complete primary tumor response. Twelve percent of patients (n = 43) had no microscopic evidence of invasive cancer in their breast and axillary specimens. A path...