title: An evaluation of predictive factors involved in clinical or pathological response to primary chemotherapy in advanced breast cancer.
abstract: BACKGROUND
  The usefulness of primary chemotherapy has been widely recognized and applied to routine clinical practice to improve prognosis by downstaging. Nevertheless, none of many trials has been able to show a positive effect of primary chemotherapy in terms of prognosis, and predictive factors of outcome have not been defined and are still under investigation.
  
  
  METHODS
  Primary chemotherapy was given to 50 patients with advanced breast cancer. Predictive factors involved in clinical or pathological response to primary chemotherapy (3 cycles of CE(F) therapy ) were investigated.
  
  
  RESULTS
  The response rate in all patients was 56.0% (CR: 3 patients PR: 25 patients) and 64.1% in patients without distant metastases. MIB-1 was related to the clinical response and EIC (extensive intraductal component) was related to the pathological response; the response was high in patients with EIC negative tumors. Responders had tumors with higher proliferative activity, which decreased significantly after chemotherapy. Patients with a decrease of more than 30% in proliferative activity after chemotherapy had significantly higher disease-free survival rates.
  
  
  CONCLUSIONS
  The proliferative activity and EIC status were useful predictors of clinical or pathological response to primary chemotherapy. A decrease in proliferative activity by chemotherapy significantly correlated with clinical response and reflected a favorable prognosis. The number of patients benefiting from primary chemotherapy might steadily increase by detecting these predictive factors.
authors.affiliation: Department of Surgery, Kumamoto City Hospital, 1-1-60 Kotoh, Kumamoto City, Kumamoto 862-8505, Japan.
authors.forename: Reiki
authors.initials: R
authors.lastname: Nishimura
authors.forename: Kazuharu
authors.initials: K
authors.lastname: Nagao
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Miyayama
authors.forename: Masakazu
authors.initials: M
authors.lastname: Matsuda
authors.forename: Ken-Ichirou
authors.initials: K
authors.lastname: Baba
authors.forename: Yukio
authors.initials: Y
authors.lastname: Matsuoka
authors.forename: Hiroya
authors.initials: H
authors.lastname: Yamashita
authors.forename: Makoto
authors.initials: M
authors.lastname: Fukuda
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D003520:Cyclophosphamide / Q000008:administration & dosage; D003561:Cytarabine; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D015412:Mastectomy, Segmental / Q000379:methods; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011336:Probability; D011379:Prognosis; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D003561:Cytarabine; D015251:Epirubicin; D003520:Cyclophosphamide; D005472:Fluorouracil