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Tumor Response Ratio Predicts Overall Survival in Breast Cancer Patients Treated with Neoadjuvant Chemotherapy

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Neoadjuvant chemotherapy (NAC) is commonly used to treat locally advanced breast cancer. Pathologic complete response (pCR) predicts improved overall survival (OS); however, prognosis of patients with partial response remains unclear. We evaluated whether tumor response ratio (TRR) is a better predictor of OS than current staging methods.

Methods

Using the National Comprehensive Cancer Network Breast Cancer Outcomes Database, we identified patients with stage I–III breast cancer who had NAC and pretreatment imaging at City of Hope (1997–2010). Patient demographics, tumor characteristics, and OS were analyzed. TRR was calculated as residual in-breast disease divided by size on pre-NAC imaging. Four TRR groups were stratified; TRR 0 (pCR), TRR > 0–0.4 (strong partial response, SPR), TRR > 0.4–1.0 (weak partial response, WPR), or TRR > 1.0 (tumor growth, TG). OS was estimated by the Kaplan–Meier method and tested by the log-rank test. Cox regression was performed to evaluate associations between OS and TRR in a multivariable analysis while controlling for potential confounders.

Results

There were 218 eligible patients identified; 59 (27 %) had pCR, 61 (28 %) SPR, 72 (33 %) WPR, and 26 (12 %) TG. Five-year OS decreased continuously with increasing TRR:pCR (90 %), SPR (79 %), WPR (66 %), and TG (60 %). TRR was the only measure that significantly predicted OS (p = 0.0035); pathologic stage (p = 0.23) and pre-NAC clinical tumor stage (cT) (p = 0.87) were not significant. TRR continued to be statistically significant by multivariable analysis (p = 0.016).

Conclusions

TRR takes into account both pretreatment and residual disease and more accurately predicts OS than pathologic stage and pre-NAC cT. TRR may be useful to more accurately assess prognosis and OS in breast cancer patients undergoing NAC.

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Acknowledgment

The authors thank Nicola Solomon, PhD, for editorial assistance.

Disclosure

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Surgical Oncology, City of Hope, Duarte, CA, USA

    Marian Miller MD, Laura Kruper MD, MSCE, Steven L. Chen MD, MBA & Courtney Vito MD

  2. Department of Information Sciences, City of Hope, Duarte, CA, USA

    Rebecca A. Ottesen MS & Joyce C. Niland PhD

Authors
  1. Marian Miller MD
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  2. Rebecca A. Ottesen MS
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  3. Joyce C. Niland PhD
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  4. Laura Kruper MD, MSCE
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  5. Steven L. Chen MD, MBA
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  6. Courtney Vito MD
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Corresponding author

Correspondence to Courtney Vito MD.

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Miller, M., Ottesen, R.A., Niland, J.C. et al. Tumor Response Ratio Predicts Overall Survival in Breast Cancer Patients Treated with Neoadjuvant Chemotherapy. Ann Surg Oncol 21, 3317–3323 (2014). https://doi.org/10.1245/s10434-014-3922-0

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  • DOI: https://doi.org/10.1245/s10434-014-3922-0

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