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Lymphovascular invasion after neoadjuvant chemotherapy is strongly associated with poor prognosis in breast carcinoma



Few studies evaluated the prognostic value of the presence of lymphovascular invasion (LVI) after neoadjuvant chemotherapy (NAC) for breast cancer (BC).


The association between LVI and survival was evaluated in a cohort of BC patients treated by NAC between 2002 and 2011. Five post-NAC prognostic scores (ypAJCC, RCB, CPS, CPS + EG and Neo-Bioscore) were evaluated and compared with or without the addition of LVI.


Out of 1033 tumors, LVI was present on surgical specimens in 29.2% and absent in 70.8% of the cases. Post-NAC LVI was associated with impaired disease-free survival (DFS) (HR 2.54; 95% CI 1.96–3.31; P < 0.001), and the magnitude of this effect depended on BC subtype (Pinteraction = 0.003), (luminal BC: HR 1.83; P = 0.003; triple negative BC: HR 3.73; P < 0.001; HER2-positive BC: HR 6.21; P < 0.001). Post-NAC LVI was an independent predictor of local relapse, distant metastasis, and overall survival; and increased the accuracy of all five post-NAC prognostic scoring systems.


Post-NAC LVI is a strong independent prognostic factor that: (i) should be systematically reported in pathology reports; (ii) should be used as stratification factor after NAC to propose inclusion in second-line trials or adjuvant treatment; (iii) should be included in post-NAC scoring systems.

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Akaike information criterion


Breast cancer


Body mass index (kg/m2)


Ductal carcinoma in situ


Disease-free survival


Oestrogen receptor


Lymphovascular invasion


Metastasis-free survival


Neoadjuvant chemotherapy


Nottingham Clinico-Pathological Response Index


No specific type


Overall survival


Pathological complete response


Progesterone receptor


Residual cancer burden


Recurrence-free survival


Triple negative breast cancer


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We thank Roche* France for financial support for construction of the Institut Curie neoadjuvant database (NEOREP). The funding source had no role in data analysis and interpretation neither in writing the manuscript. AS Hamy was supported by an ITMO-INSERM-AVIESAN cancer translational research grant.


This work was supported by the Site de Recherche Intégrée en Cancérologie/Institut National du Cancer (INCa-DGOS-4654); and Grant ARC Fundation 2013 (SL220130607090).

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Correspondence to Fabien Reyal.

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This report describes an original work and is not under consideration by any other journal. All authors approved the manuscript and this submission. There are no conflicts of interest.

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Hamy, AS., Lam, GT., Laas, E. et al. Lymphovascular invasion after neoadjuvant chemotherapy is strongly associated with poor prognosis in breast carcinoma. Breast Cancer Res Treat 169, 295–304 (2018).

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  • Breast carcinoma
  • Lymphovascular invasion
  • Neoadjuvant chemotherapy
  • Prognostic scores