Skip to main content

Advertisement

SpringerLink
Log in

Patient and tumor characteristics associated with breast cancer recurrence after complete pathological response to neoadjuvant chemotherapy

  • Clinical trial
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Breast cancer patients whose tumors achieve a pathological complete response (pCR) with neoadjuvant chemotherapy have a prognosis which is better than that predicted for the stage of their disease. However, within this subgroup of patients, recurrences have been observed. We sought to examine factors associated with recurrence in a population of breast cancer patients who achieved a pCR with neoadjuvant chemotherapy. A retrospective chart review was conducted of all patients with unilateral breast cancer treated with neoadjuvant chemotherapy from January 1, 2000 to December 31, 2010 at one comprehensive cancer center. A pCR was defined as no residual invasive cancer in the breast in the surgical specimen following neoadjuvant therapy. Recurrence was defined as visceral or bony reappearance of cancer after completion of all therapy. Of 818 patients who completed neoadjuvant chemotherapy, 144 (17.6 %) had pCR; six with bilateral breast cancer were excluded from further analysis. The mean time to follow-up was 47.2 months. Among the 138 patients with unilateral breast cancer, there were 14 recurrences (10.1 %). Using a binary multiple logistic regression model, examining types of chemotherapy and surgery, race, lymph node assessment, and lymph node status, breast cancer side, triple-negative status, and radiation receipt, only African-American patients (OR: 5.827, 95 % CI: 1.280–26.525; p = 0.023) were more likely to develop distant recurrence. The mean time to recurrence was 31.9 months. In our study, race was the only independent predictor of recurrence after achieving pCR with neoadjuvant chemotherapy. The reasons for this observation require further study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. National Cancer Institute: Breast Cancer Home Page (2009) http://www.cancer.gov/cancertopics/types/breast. Accessed 14 August 2009

  2. Bonadonna G, Valagussa P, Brambilla C, Ferrari L, Moliterni A, Terenziani M, Zambetti M (1998) Primary chemotherapy in operable breast cancer: eight-year experience at the Milan Cancer Institute. J Clin Oncol 16(1):93–100

    PubMed  CAS  Google Scholar 

  3. Chollet P, Charrier S, Brain E, Curé H, van Praagh I, Feillel V, de Latour M, Dauplat J, Misset JL, Ferrière JP (1997) Clinical and pathological response to primary chemotherapy in operable breast cancer. Eur J Cancer 33(6):862–866

    Article  PubMed  CAS  Google Scholar 

  4. Jacquillat C, Weil M, Baillet F, Borel C, Auclerc G, de Maublanc MA, Housset M, Forget G, Thill L, Soubrane C, Khayat D (1990) Results of neoadjuvant chemotherapy and radiation therapy in the breast-conserving treatment of 250 patients with all stages of infiltrative breast cancer. Cancer 66(1):119–129

    Article  PubMed  CAS  Google Scholar 

  5. Kaufmann M, von Minckwitz G, Smith R, Valero V, Gianni L, Eiermann W, Howell A, Costa SD, Beuzeboc P, Untch M, Blohmer JU, Sinn HP, Sittek R, Souchon R, Tulusan AH, Volm T, Senn HJ (2003) International expert panel on the use of primary (preoperative) systemic treatment of operable breast cancer: review and recommendations. J Clin Oncol 21:2600–2608

    Article  PubMed  Google Scholar 

  6. Smith IE, Walsh G, Jones A, Prendiville J, Johnston S, Gusterson B, Ramage F, Robertshaw H, Sacks N, Ebbs S (1995) High complete remission rates with primary neoadjuvant infusional chemotherapy for large early breast cancer. J Clin Oncol 13(2):424–429

    PubMed  CAS  Google Scholar 

  7. Bear HD, Anderson S, Brown A, Smith R, Mamounas EP, Fisher B, Margolese R, Theoret H, Soran A, Wickerham DL, Wolmark N, National Surgical Adjuvant Breast and Bowel Project Protocol B-27 (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(22):4165–4174

    Article  PubMed  CAS  Google Scholar 

  8. Fisher B, Brown A, Mamounas E, Wieand S, Robidoux A, Margolese RG, Cruz AB Jr, Fisher ER, Wickerham DL, Wolmark N, DeCillis A, Hoehn JL, Lees AW, Dimitrov NV (1997) Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-18. J Clin Oncol 15(7):2483–2493

    PubMed  CAS  Google Scholar 

  9. Fisher B, Bryant J, Wolmark N, Mamounas E, Brown A, Fisher ER, Wickerham DL, Begovic M, DeCillis A, Robidoux A, Margolese RG, Cruz AB Jr, Hoehn JL, Lees AW, Dimitrov NV, Bear HD (1998) Effect of preoperative chemotherapy on the outcome of women with operable breast cancer. J Clin Oncol 16(8):2672–2685

    PubMed  CAS  Google Scholar 

  10. van der Hage JA, van de Velde CJ, Julien JP, Tubiana-Hulin M, Vandervelden C, Duchateau L (2001) Preoperative chemotherapy in primary operable breast cancer: results from the European Organization for Research and Treatment of Cancer Trial 10902. J Clin Oncol 19(22):4224–4237

    PubMed  Google Scholar 

  11. Kuerer HM, Newman LA, Smith TL, Ames FC, Hunt KK, Dhingra K, Theriault RL, Singh G, Binkley SM, Sneige N, Buchholz TA, Ross MI, McNeese MD, Buzdar AU, Hortobagyi GN, Singletary SE (1999) Clinical course of breast cancer patients with complete pathologic primary tumor and axillary lymph node response to doxorubicin-based neoadjuvant chemotherapy. J Clin Oncol 17(2):441–444

    Google Scholar 

  12. Smith IC, Heys SD, Hutcheon AW, Miller ID, Payne S, Gilbert FJ, Ah-See AK, Eremin O, Walker LG, Sarkar TK, Eggleton SP, Ogston KN (2002) Neoadjuvant chemotherapy in breast cancer: significantly enhanced response with docetaxel. J Clin Oncol 20(6):1456–1466

    Article  PubMed  CAS  Google Scholar 

  13. Untch M, Möbus V, Kuhn W, Muck BR, Thomssen C, Bauerfeind I, Harbeck N, Werner C, Lebeau A, Schneeweiss A, Kahlert S, von Koch F, Petry KU, Wallwiener D, Kreienberg R, Albert US, Lück HJ, Hinke A, Jänicke F, Konecny GE (2009) Dose-dense sequential epirubicin-paclitaxel as preoperative treatment of breast cancer: results of a randomised AGO study. J Clin Oncol 27(18):2938–2945

    Article  PubMed  Google Scholar 

  14. Gonzalez-Angulo AM, McGuire SE, Buchholz TA, Tucker SL, Kuerer HM, Rouzier R, Kau SW, Huang EH, Morandi P, Ocana A, Cristofanilli M, Valero V, Buzdar AU, Hortobagyi GN (2005) Factors predictive of distant metastases in patients with breast cancer who have a pathologic complete response after neoadjuvant chemotherapy. J Clin Oncol 23(28):7098–7104

    Article  PubMed  Google Scholar 

  15. Tanioka M, Shimizu C, Yonemori K, Yoshimura K, Tamura K, Kouno T, Ando M, Katsumata N, Tsuda H, Kinoshita T, Fujiwara Y (2010) Predictors of recurrence in breast cancer patients with a pathologic complete response after neoadjuvant chemotherapy. Br J Cancer 103(3):297–302

    Article  PubMed  CAS  Google Scholar 

  16. Gajdos C, Tartter PI, Estabrook A, Gistrak MA, Jaffer S, Bleiweiss IJ (2002) Relationship of clinical and pathologic response to neoadjuvant chemotherapy and outcome of locally advanced breast cancer. J Surg Oncol 80(1):4–11

    Article  PubMed  Google Scholar 

  17. Kuerer HM, Newman LA, Smith TL, Ames FC, Hunt KK, Dhingra K, Theriault RL, Singh G, Binkley SM, Sneige N, Buchholz TA, Ross MI, McNeese MD, Buzdar AU, Hortobagyi GN, Singletary SE (1999) Clinical course of breast cancer patients with complete pathologic primary tumor and axillary lymph node response to doxorubicin-based neoadjuvant chemotherapy. J Clin Oncol 17(2):460–469

    PubMed  CAS  Google Scholar 

  18. Smigal C, Jemal A, Ward E, Cokkinides V, Smith R, Howe HL, Thun M (2006) Trends in breast cancer by race and ethnicity: update. CA Cancer J Clin 56(3):168–183

    Article  PubMed  Google Scholar 

  19. Ghafoor A, Jemal A, Ward E, Cokkinides V, Smith R, Thun M (2003) Trends in breast cancer by race and ethnicity. CA Cancer J Clin 53(6):342–355 Erratum in: CA Cancer J Clin. 2004 May–Jun;54(3):181

    Article  PubMed  Google Scholar 

  20. Chevarley F, White E (1997) Recent trends in breast cancer mortality among white and black US women. Am J Public Health 87(5):775–781

    Article  PubMed  CAS  Google Scholar 

  21. Fisher B, Gunduz N, Coyle J, Rudock C, Saffer E (1989) Presence of a growth-stimulating factor in serum following primary tumor removal in mice. Cancer Res 49:1996–2001

    PubMed  CAS  Google Scholar 

  22. Fisher B, Gunduz N, Saffer EA (1983) Influence of the interval between primary tumor removal and chemotherapy on kinetics and growth of metastases. Cancer Res 43:1488–1492

    PubMed  CAS  Google Scholar 

  23. Fisher B, Saffer E, Rudock C, Coyle J, Gunduz N (1989) Effect of local or systemic treatment prior to primary tumor removal on the production and response to a serum growth-stimulating factor in mice. Cancer Res 49:2002–2004

    PubMed  CAS  Google Scholar 

  24. Mauri D, Pavlidis N, Ioannidis JP (2005) Neoadjuvant versus adjuvant systemic treatment in breast cancer: a meta-analysis. J Natl Cancer Inst 97(3):188–194

    Article  PubMed  Google Scholar 

  25. Sachelarie I, Grossbard ML, Chadha M, Feldman S, Ghesani M, Blum RH (2006) Primary systemic therapy of breast cancer. Oncologist 11:574–589

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This study was funded in part by a National Heart Lung and Blood Institute training grant (T35 HL007815-1) and by the National Cancer Institute Cancer Center Support Grant (P30 CA91842) to the Siteman Cancer Center for use of Health Behavior, Communication, and Outreach Core.

Disclosures

None of the authors have disclosures or conflict of interest.

Author information

Authors and Affiliations

  1. Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO, 63110, USA

    Na Rae Ju, Jason Keune & Rebecca Aft

  2. Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA

    Donna B. Jeffe

  3. Alvin J. Siteman Cancer Center, St. Louis, MO, USA

    Donna B. Jeffe & Rebecca Aft

  4. John Cochran Veterans Hospital, St. Louis, MO, USA

    Rebecca Aft

Authors
  1. Na Rae Ju
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Donna B. Jeffe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jason Keune
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rebecca Aft
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rebecca Aft.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ju, N.R., Jeffe, D.B., Keune, J. et al. Patient and tumor characteristics associated with breast cancer recurrence after complete pathological response to neoadjuvant chemotherapy. Breast Cancer Res Treat 137, 195–201 (2013). https://doi.org/10.1007/s10549-012-2312-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-012-2312-1

Keywords

Search

Navigation