title: Prognostic value of persistent node involvement after neoadjuvant chemotherapy in patients with operable breast cancer.
abstract: Neoadjuvant chemotherapy is able to reduce the size of the majority of breast tumours and down-stage axillary-node status. The aim of this study was to assess the prognostic value of persistent node involvement after neoadjuvant chemotherapy. A total of 488 patients with T2-T3, N0-N1 breast cancer treated by neoadjuvant chemotherapy followed by tumour excision and axillary lymph-node dissection between 1981 and 1992 were selected from the Institut Curie database. Median follow-up was 7 years. Overall objective response rate before local treatment was 52% and breast tumour size was reduced in 83% of patients. No pathologic nodal involvement was observed in 46. 5% of patients. Patients with > or = eight positive nodes had a very poor median disease-free survival of only 20 months. Their 10-year disease-free survival rate was 7%, while the 10-year disease-free survival rate for patients with no node involvement was 64%. Median survival for patients with > or = eight nodes positive was 48 months and the 10-year survival rate was 26% (P < 0.0001). On multivariate analysis, outcome was strongly correlated with pathological nodal status, tumour grade, hormonal receptor status and clinical response of the tumour. In conclusion, patients with extensive nodal involvement after neoadjuvant chemotherapy have a very poor outcome. Second-line treatment should be considered in this population.
authors.affiliation: Medical Oncology Department, Institut Curie, 26 Rue d'Ulm, Paris Cedex 05, 75248, France.
authors.forename: J Y
authors.initials: JY
authors.lastname: Pierga
authors.forename: E
authors.initials: E
authors.lastname: Mouret
authors.forename: V
authors.initials: V
authors.lastname: Diéras
authors.forename: V
authors.initials: V
authors.lastname: Laurence
authors.forename: P
authors.initials: P
authors.lastname: Beuzeboc
authors.forename: T
authors.initials: T
authors.lastname: Dorval
authors.forename: T
authors.initials: T
authors.lastname: Palangié
authors.forename: M
authors.initials: M
authors.lastname: Jouve
authors.forename: A
authors.initials: A
authors.lastname: Vincent-Salomon
authors.forename: S
authors.initials: S
authors.lastname: Scholl
authors.forename: J M
authors.initials: JM
authors.lastname: Extra
authors.forename: B
authors.initials: B
authors.lastname: Asselain
authors.forename: P
authors.initials: P
authors.lastname: Pouillart
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D001365:Axilla; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D015996:Survival Rate; D013852:Thiotepa / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D015251:Epirubicin; D004317:Doxorubicin; D003520:Cyclophosphamide; D013852:Thiotepa; D005472:Fluorouracil