Annals of Surgical Oncology

, Volume 19, Issue 9, pp 3002–3011 | Cite as

Prognostic Value of a Positive-to-negative Change in Hormone Receptor Status after Neoadjuvant Chemotherapy in Patients with Hormone Receptor–positive Breast Cancer

  • Sheng Chen
  • Can-Ming Chen
  • Ke-Da Yu
  • Ruo-Ji Zhou
  • Zhi-Ming Shao
Breast Oncology

Abstract

Background

To investigate the prognostic value of positive-to-negative changes in hormone receptor (HR) status after neoadjuvant chemotherapy (NCT) in patients with HR-positive breast cancer.

Methods

Data from 224 stage II–III breast cancer patients with positive HR status before NCT who had residual disease in the breast after NCT were collected. HR status of the residual tumors was retested after NCT. A survival analysis was performed in 214 patients with adjuvant endocrine therapy regardless of post-NCT HR status. The survival analysis also examined other clinical and pathologic variables.

Results

In total, 15.2 % of patients had a positive-to-negative change in HR status after NCT, and this change was observed more frequently in HER-2-positive tumors than HER-2-negative tumors (P = 0.001). In 214 patients who had been treated with adjuvant endocrine therapy regardless of post-NCT HR status, the alteration in HR status was an independent factor for the prediction of a poorer disease-free survival (P = 0.026) and overall survival (P < 0.001) in the adjuvant endocrine therapy patients. The 5-year disease-free survival and overall survival rates were 43.5 % and 59.8 %, respectively, in patients with HR status conversion and 67.8 % and 82.5 %, respectively, in patients whose HR status remained positive (log rank test P = 0.003 and P = 0.001).

Conclusions

The switch of HR status after NCT is remarkable for HR-positive tumors. An HR-negative switch may identify patients who would benefit from alternative systemic therapies.

Keywords

Overall Survival Estrogen Receptor Partial Response Hormone Receptor Core Needle Biopsy 

Notes

Acknowledgement

This research is supported by the Key Clinical Program of the Ministry of Health (2010-2012), the 2009 Youth Foundation of Shanghai Public Health Bureau, and the Shanghai Committee of Science and Technology Fund for 2011 Qimingxing Project (11QA1401400). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Conflict of interest

All authors declared no potential conflicts of interest.

References

  1. 1.
    Hortobagyi GN. Comprehensive management of locally advanced breast cancer. Cancer. 1990;66:1387–91.PubMedCrossRefGoogle Scholar
  2. 2.
    Schwartz GF, Hortobagyi GN. Proceedings of the consensus conference on neoadjuvant chemotherapy in carcinoma of the breast, April 26–28, 2003, Philadelphia, Pennsylvania. Cancer. 2004;100:2512–32.PubMedCrossRefGoogle Scholar
  3. 3.
    Mauri D, Pavlidis N, Ioannidis JP. Neoadjuvant versus adjuvant systemic treatment in breast cancer: a meta-analysis. J Natl Cancer Inst. 2005;97:188–94.PubMedCrossRefGoogle Scholar
  4. 4.
    Lee J, Im YH, Lee SH, et al. Evaluation of ER and Ki-67 proliferation index as prognostic factors for survival following neoadjuvant chemotherapy with doxorubicin/docetaxel for locally advanced breast cancer. Cancer Chemother Pharmacol. 2008;61:569–77.PubMedCrossRefGoogle Scholar
  5. 5.
    Rouzier R, Perou CM, Symmans WF, et al. Breast cancer molecular subtypes respond differently to preoperative chemotherapy. Clin Cancer Res. 2005;11:5678–85.PubMedCrossRefGoogle Scholar
  6. 6.
    Tordai A, Wang J, Andre F, et al. Evaluation of biological pathways involved in chemotherapy response in breast cancer. Breast Cancer Res. 2008;10:R37.PubMedCrossRefGoogle Scholar
  7. 7.
    Colleoni M, Bagnardi V, Rotmensz N, et al. A nomogram based on the expression of Ki-67, steroid hormone receptors status and number of chemotherapy courses to predict pathological complete remission after preoperative chemotherapy for breast cancer. Eur J Cancer. 2010;46:2216–24.PubMedCrossRefGoogle Scholar
  8. 8.
    Zhang N, Moran MS, Huo Q, et al. The hormonal receptor status in breast cancer can be altered by neoadjuvant chemotherapy: a meta-analysis. Cancer Invest. 2011;29:594–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45:228–47.PubMedCrossRefGoogle Scholar
  10. 10.
    Arnedos M, Nerurkar A, Osin P, et al. Discordance between core needle biopsy (CNB) and excisional biopsy (EB) for estrogen receptor (ER), progesterone receptor (PgR) and HER2 status in early breast cancer (EBC). Ann Oncol. 2009;20:1948–52.PubMedCrossRefGoogle Scholar
  11. 11.
    Hammond ME, Hayes DF, Dowsett M, et al. American Society of Clinical Oncology/College of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. J Clin Oncol. 2010;28:2784–95.PubMedCrossRefGoogle Scholar
  12. 12.
    Kasami M, Uematsu T, Honda M, et al. Comparison of estrogen receptor, progesterone receptor and Her-2 status in breast cancer pre- and post-neoadjuvant chemotherapy. Breast. 2008;17:523–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Hirata T, Shimizu C, Yonemori K, et al. Change in the hormone receptor status following administration of neoadjuvant chemotherapy and its impact on the long-term outcome in patients with primary breast cancer. Br J Cancer. 2009;101:1529–36.PubMedCrossRefGoogle Scholar
  14. 14.
    Taucher S, Rudas M, Gnant M, et al. Sequential steroid hormone receptor measurements in primary breast cancer with and without intervening primary chemotherapy. Endocr Relat Cancer. 2003;10:91–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Tacca O, Penault-Llorca F, Abrial C, et al. Changes in and prognostic value of hormone receptor status in a series of operable breast cancer patients treated with neoadjuvant chemotherapy. Oncologist. 2007;12:636–43.PubMedCrossRefGoogle Scholar
  16. 16.
    Faneyte IF, Schrama JG, Peterse JL, et al. Breast cancer response to neoadjuvant chemotherapy: predictive markers and relation with outcome. Br J Cancer. 2003;88:406–12.PubMedCrossRefGoogle Scholar
  17. 17.
    Varga Z, Caduff R, Pestalozzi B. Stability of the HER2 gene after primary chemotherapy in advanced breast cancer. Virchows Arch. 2005;446:136–41.PubMedCrossRefGoogle Scholar
  18. 18.
    Penault-Llorca F, Cayre A, Bouchet Mishellany F, et al. Induction chemotherapy for breast carcinoma: predictive markers and relation with outcome. Int J Oncol. 2003;22:1319–25.PubMedGoogle Scholar
  19. 19.
    van de Ven S, Smit VT, Dekker TJ, et al. Discordances in ER, PR and HER2 receptors after neoadjuvant chemotherapy in breast cancer. Cancer Treat Rev. 2011;37:422–30.PubMedGoogle Scholar
  20. 20.
    Jones RL, Salter J, A’Hern R, et al. The prognostic significance of Ki67 before and after neoadjuvant chemotherapy in breast cancer. Breast Cancer Res Treat. 2009;116:53–68.PubMedCrossRefGoogle Scholar
  21. 21.
    Abrial SC, Penault-Llorca F, Delva R, et al. High prognostic significance of residual disease after neoadjuvant chemotherapy: a retrospective study in 710 patients with operable breast cancer. Breast Cancer Res Treat. 2005;94:255–63.PubMedCrossRefGoogle Scholar
  22. 22.
    Petit T, Wilt M, Velten M, et al. Comparative value of tumour 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. 2004;40:205–11.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2012

Authors and Affiliations

  • Sheng Chen
    • 1
    • 2
  • Can-Ming Chen
    • 1
    • 2
  • Ke-Da Yu
    • 1
    • 2
  • Ruo-Ji Zhou
    • 2
    • 3
  • Zhi-Ming Shao
    • 1
    • 2
    • 4
  1. 1.Department of Breast SurgeryFudan University Shanghai Cancer Center/Cancer InstituteShanghaiPeople’s Republic of China
  2. 2.Department of OncologyShanghai Medical College, Fudan UniversityShanghaiPeople’s Republic of China
  3. 3.Department of PathologyFudan University Shanghai Cancer Center/Cancer InstituteShanghaiPeople’s Republic of China
  4. 4.Institutes of Biomedical ScienceFudan UniversityShanghaiPeople’s Republic of China

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