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The Effect of Molecular Subtype and Residual Disease on Locoregional Recurrence in Breast Cancer Patients Treated with Neoadjuvant Chemotherapy and Postmastectomy Radiation

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

Abstract

Background

The relative contribution of biologic subtype to locoregional recurrence (LRR) in patients treated with neoadjuvant chemotherapy (NAC), mastectomy, and postmastectomy radiotherapy (PMRT) is not clearly defined.

Methods

233 patients with stages 2 and 3 breast cancer who received NAC, mastectomy, and PMRT between 2000 and 2009 were included: 53 % (n = 123) had HR+ (ER or PR+/HER2−), 23 % (n = 53) had HER2+ (HER2+/HR+ or HR−), and 24 % (n = 57) had triple-negative (TN) disease (HR−/HER2−). The 5-year LRR rates were estimated by Kaplan–Meier methods. Cox regression analysis was performed to evaluate covariates associated with LRR.

Results

The median follow-up period was 62 months. A pathologic complete response (pCR) was seen in 14 % of the patients. The 5-year LRR rate was 8 % for the entire cohort. The LRR rate was 0 % for the patients with a pCR versus 9 % for the patients without a pCR (p = 0.05). TN disease [Hazard ratio (HR) 4.4; p = 0.003] and pathologic node positivity (HR 9.8; p = 0.03) were associated with LRR. Patients with TN disease had a higher LRR rate than patients with HER2+ or HR+ disease (20 vs. 6  and 4 %; p = 0.005). Among patients without a pCR, TN subtype was associated with increased LRR risk (26 versus 7 % HER+ and 4 % HR+; p < 0.001).

Conclusions

Patients with TN breast cancer had the highest LRR rate after NAC, mastectomy and PMRT. Whereas no LRR was observed among TN patients with a pCR, TN patients with residual disease had a significantly higher LRR risk. Patients with HR+ and HER2+ breast cancer had favorable LRR rates regardless of NAC response, likely due to receipt of adjuvant systemic targeted therapies.

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Authors and Affiliations

  1. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    T. Jonathan Yang MD, Kate Krause BS, Chun Siu BS, Beryl McCormick MD, Simon N. Powell MD, PhD & Alice Y. Ho MD

  2. Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Monica Morrow MD

  3. Breast Oncology Service, Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Shanu Modi MD

  4. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Zhigang Zhang PhD

Authors
  1. T. Jonathan Yang MD
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  2. Monica Morrow MD
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  3. Shanu Modi MD
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  4. Zhigang Zhang PhD
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  5. Kate Krause BS
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  6. Chun Siu BS
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  7. Beryl McCormick MD
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  8. Simon N. Powell MD, PhD
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  9. Alice Y. Ho MD
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Corresponding author

Correspondence to Alice Y. Ho MD.

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Yang, T.J., Morrow, M., Modi, S. et al. The Effect of Molecular Subtype and Residual Disease on Locoregional Recurrence in Breast Cancer Patients Treated with Neoadjuvant Chemotherapy and Postmastectomy Radiation. Ann Surg Oncol 22 (Suppl 3), 495–501 (2015). https://doi.org/10.1245/s10434-015-4697-7

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  • DOI: https://doi.org/10.1245/s10434-015-4697-7

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