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Annals of Surgical Oncology

, Volume 21, Issue 10, pp 3317–3323 | Cite as

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

  • Marian Miller
  • Rebecca A. Ottesen
  • Joyce C. Niland
  • Laura Kruper
  • Steven L. Chen
  • Courtney VitoEmail author
Breast Oncology

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.

Keywords

Overall Survival National Comprehensive Cancer Network Pathologic Stage National Comprehensive Cancer Network Residual Cancer Burden 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

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

Disclosure

The authors declare no conflict of interest.

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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Marian Miller
    • 1
  • Rebecca A. Ottesen
    • 2
  • Joyce C. Niland
    • 2
  • Laura Kruper
    • 1
  • Steven L. Chen
    • 1
  • Courtney Vito
    • 1
    Email author
  1. 1.Department of Surgical OncologyCity of HopeDuarteUSA
  2. 2.Department of Information SciencesCity of HopeDuarteUSA

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