Abstract
Background
There is scarce data on the outcome of young patients aged 35 years and younger, who have been treated with neoadjuvant chemotherapy. The aim of this study is to evaluate the impact of body mass index (BMI) and various prognostic factors on pathologic response and survival in young patients with localized breast cancer.
Patients and methods
This is a retrospective evaluation on the outcome of 110 patients who were younger than 35 years at diagnosis and treated with neoadjuvant chemotherapy (CT). Patients were grouped in quartiles of BMI calculated prior to initiation of chemotherapy. Logistic regression analysis was performed to investigate the associations between prognostic variables including BMI and treatment outcome. The impact of prognostic factors on survival was analyzed by Kaplan-Maier and Cox regression tests.
Results
Body mass index was not correlated with pathologic complete response (pCR) (n = 13, 11.7%) or survival. Cox regression analysis revealed nodal pCR following neoadjuvant chemotherapy (HR 2.45, P = 0.048) and stage at diagnosis (HR1.99, P = 0.027) as significant independent prognostic factors for DFS, while recurrence was independently associated with shorter OS (HR 169, P = 0.029).
Conclusion
Body mass index was not correlated with pCR or prognosis in young women with early breast cancer. Pathologic CR was shown to have a significant influence on DFS. Total axillary clearance may be used a surrogate variable in determining prognosis in young patients treated with neoadjuvant chemotherapy.
Similar content being viewed by others
References
Mano MS, Awada A (2004) Primary chemotherapy for breast cancer: the evidence and the future. Ann Oncol 15:1161–1171. doi:10.1093/annonc/mdh302
Kuerer HM, Newman LA, Smith TL et al (1999) Clinical course of breast cancer patients with complete pathological tumor and axillary lymph node response to doxorubicin-based neoadjuvant chemotherapy. J Clin Oncol 17:460–469
Kaufmann M, Hortobagyi GN, Goldhirsch A et al (2006) Recommendations from an international expert panel on the use of neoadjuvant (primary) systemic treatment of operable breast cancer: an update. J Clin Oncol 24:1940–1949. doi:10.1200/JCO.2005.02.6187
Pierga JY, Mouret E, Dieras V et al (2000) Prognostic role of persistent node involvement after neoadjuvant chemotherapy in patients with operable breast cancer. Br J Cancer 83:1480–1487. doi:10.1054/bjoc.2000.1461
Rouzier R, Extra JM, Klijanienko J et al (2002) Incidence and prognostic significance of complete axillary downstaging after primary chemotherapy in breast cancer patients with T1 to T3 tumors and cytologically proven axillary metastatic lymph nodes. J Clin Oncol 20:1304–1310. doi:10.1200/JCO.20.5.1304
Berclaz G, Li S, Price KN et al (2004) Body mass index as a prognostic feature in operable breast cancer: The International Breast Cancer Study Group experience. Ann Oncol 15:875–884. doi:10.1093/annonc/mdh222
Peacock SL, White E, Daling JR, Voight LF, Malone KE (1999) Relation between obesity and breast cancer in young women. Am J Epidemiol 149(4):339–346
Backhouse CM, Lioyd-Davies ER, Shousha S, Burn JI (1987) Carcinoma of the breast in women aged 35 years or less. Br J Surg 74:591–593. doi:10.1002/bjs.1800740716
Schmidt RT, Tsangaris TN, Cheek JH (1991) Breast cancer in women under 35 years of age. Am J Surg 62:197–201. doi:10.1016/0002-9610(91)90068-O
von Minkwitz G, Raab G, Caputo A et al (2005) Doxorubicin with cyclophosphamide followed by docetaxel every 21 days compared with doxorubicin and docetaxel every 14 days as preoperative therapy in patients with operable breast cancer: the GEPARDUO study of the German breast group. J Clin Oncol 23:2676–2685. doi:10.1200/JCO.2005.05.078
Bear HD, Anderson S, Brown A et al (2003) The effect on tumor response of adding sequential preoperative docetaxel to preoperative doxorubicin and cyclophosphamide: preliminary results from National Surgical Adjuvant Breast and Bowel Project Protocol B-27. J Clin Oncol 21:4165–4174. doi:10.1200/JCO.2003.12.005
Smith IC, Heys SD, Hutcheon AW et al (2002) Neoadjuvant chemotherapy in breast cancer significantly enhanced response to docetaxel. J Clin Oncol 20:1456–1466. doi:10.1200/JCO.20.6.1456
Martin M, Pienkowski T, Mackey J et al (2005) Adjuvant docetaxel for node-positive breast cancer. N Engl J Med 352:2302–2313. doi:10.1056/NEJMoa043681
Roche H, Fumoleau P, Spielmann M et al (2006) Sequential adjuvant epirubicin-based and docetaxel chemotherapy for node positive breast cancer patients: the FNCLCC PACS 01 trial. J Clin Oncol 24:5664–5671. doi:10.1200/JCO.2006.07.3916
Petit T, Wilt M, Velten M et al (2004) Comparative value of tumor grade, hormonal receptors, Ki–67, HER-2 and topoisomerase II alpha status as predictive markers in breast cancer patients treated with neoadjuvant anthracycline-based chemotherapy. Eur J Cancer 40:205–211. doi:10.1016/S0959-8049(03)00675-0
Guarneri V, Broglio K, Kau SW et al (2006) Prognostic value of pathologic complete response after primary chemotherapy in relation to hormone receptor status and other factors. J Clin Oncol 24:1037–1044. doi:10.1200/JCO.2005.02.6914
Penault-Llorca FM, Amat S, De Latour M, et al. (2002) Scarff-Bloom-Richardson grading: from predictive to prognostic significance in invasive ductal breast carcinomas treated by neoadjuvant chemotherapy. Br Cancer Res Treat 76(suppl 1):abstract 153
Fisher ER, Wang J, Bryant J et al (2002) Pathobiology of preoperative chemotherapy findings from the National Surgical Adjuvant Breast and Bowel Project Protocol B-18. Cancer 95:681–695. doi:10.1002/cncr.10741
Marret H, Perrotin F, Bougnoux P et al (2001) Low body mass index is an independent risk factor of local recurrence after conservative treatment for breast cancer. Breast Cancer Res Treat 66:17–23. doi:10.1023/A:1010699912768
Bastarrachea J, Hortobagyi GN, Smith TL, Kau SWC, Buzdar AU (1993) Obesity as an adverse prognostic factor for patients receiving adjuvant chemotherapy for breast cancer. Ann Intern Med 119:18–25
Daling JR, Malone KE, Doody DR, Johnson LG, Gralow JR, Porter PL (2001) Relation of body mass index to tumor markers and survival among young women with invasive ductal breast carcinoma. Cancer 92:720–729. doi: 10.1002/1097-0142(20010815)92:4<720::AID-CNCR1375>3.0.CO;2-T
Katoh A, Watzlaf VJM, D’Amico F (1994) An examination of obesity and breast cancer survival in post-menopausal women. Br J Cancer 70:928–933
den Tonkelaar I, de Waard F, Seidell JC et al (1995) Obesity and subcutaneous fat patterning in relation to survival of postmenopausal breast cancer patients participating in the DOM-project. Breast Cancer Res Treat 34:129–137. doi:10.1007/BF00665785
Kaye SA, Folsom AR, Soler JT et al (1991) Associations of body mass and fat distribution with sex hormone concentrations in postmenopausal women. Int J Epidemiol 20:151–156. doi:10.1093/ije/20.1.151
Yu H, Rohan T (2000) The role of insulin-like growth factor family in cancer development and progression. J Natl Cancer Inst 92:1472–1489. doi:10.1093/jnci/92.18.1472
Kumar NB, Cantor A, Allen K, Cox CE (2000) Android obesity at diagnosis and breast carcinoma survival: Evaluation of the effects of anthropometric variables at diagnosis, including body composition and body fat distribution and weight gain during life span and survival from breast carcinoma. Cancer 88:2751–2757. doi: 10.1002/1097-0142(20000615)88:12<2751::AID-CNCR13>3.0.CO;2-1
Powis G, Reece P, Ahmann DL, Ingle JN (1987) Effect of body weight on the pharmacokinetics of cyclophosphamide in breast cancer patients. Cancer Chemother Pharmacol 20:219–222. doi:10.1007/BF00570489
Rodvold KA, Rushing DA, Tewksbury DA (1987) Doxorubicin clearence in the obese. J Clin Oncol 6:1321–1327
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Eralp, Y., Smith, T.L., Altundağ, K. et al. Clinical features associated with a favorable outcome following neoadjuvant chemotherapy in women with localized breast cancer aged 35 years or younger. J Cancer Res Clin Oncol 135, 141–148 (2009). https://doi.org/10.1007/s00432-008-0428-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00432-008-0428-9