Long-Term Prognostic Risk After Neoadjuvant Chemotherapy Associated With Residual Cancer Burden and Breast Cancer Subtype

作者：W. Fraser Symmans, Caimiao Wei, Rebekah Gould, Xianjun Yu, Ya Zhang, Mei Liu, Andrew F. Walls, Alex Bousamra, Maheshwari Ramineni, Bruno Valentin Sinn, Kelly K. Hunt, Thomas A. Buchholz, Vicente Valero, Aman U. Buzdar, Wei Tse Yang, Abenaa M. Brewster, Stacy L. Moulder, Lajos Pusztai, Christos Hatzis, Gabriel N. Hortobágyi · 发表于：Journal of Clinical Oncology · 年份：2017 · DOI：10.1200/jco.2015.63.1010 · 被引用次数：744 · 研究领域：Breast Cancer Treatment Studies、HER2/EGFR in Cancer Research、Breast Lesions and Carcinomas

Purpose To determine the long-term prognosis in each phenotypic subset of breast cancer related to residual cancer burden (RCB) after neoadjuvant chemotherapy alone, or with concurrent human epidermal growth factor receptor 2 (HER2)-targeted treatment. Methods We conducted a pathologic review to measure the continuous RCB index (wherein pathologic complete response has RCB = 0; residual disease is categorized into three predefined classes of RCB index [RCB-I, RCB-II, and RCB-III]), and yp-stage of residual disease. Patients were prospectively observed for survival. Three patient cohorts received paclitaxel (T) followed by fluorouracil, doxorubicin, and cyclophosphamide (T/FAC): original development cohort (T/FAC-1), validation cohort (T/FAC-2), and independent validation cohort (T/FAC-3). Another validation cohort received FAC chemotherapy only, and a fifth cohort received concurrent trastuzumab (H) with sequential paclitaxel and fluorouracil, epirubicin, and cyclophosphamide (FEC; H+T/FEC). Phenotypic subsets were defined by hormone receptor (HR) and HER2 status at diagnosis, classified as HR-positive/HER2-negative, HER2-positive (HR-negative/HER2-positive or HR-positive/HER2-positive), or triple receptor-negative. Relapse-free survival estimates were determined from Kaplan-Meier analysis and compared using the log-rank test. Results Five cohorts (T/FAC-1 [n = 219], T/FAC-2 [n = 262], T/FAC-3 [n = 342], FAC [n = 132], and H+T/FEC [n = 203]) had median event-free follow-up of...