title: Only grading has independent impact on breast cancer survival after adjustment for pathological response to preoperative chemotherapy.
abstract: Our objective was to determine pretreatment factors with an independent impact on survival after adjusting for response to preoperative chemotherapy and to describe parameters predictive for achieving a pathological complete remission (pCR) after preoperative chemotherapy containing an anthracycline. We performed univariate and multivariate analyses to describe the impact of the following pretreatment characteristics of 240 primary breast cancer patients who received preoperative chemotherapy containing an anthracycline at our institution on disease-free survival (DFS), distant disease-free survival (DDFS) and overall survival (OS): age, stage, clinical tumor size, clinical nodal status, grading, and expression of estrogen receptor, progesterone receptor, Her2/neu, Ki67, Bcl-2 and p53. Afterwards, the response to preoperative chemotherapy was added to the multivariate model in order to evaluate which pretreatment parameters retained their prognostic impact. In addition, univariate analysis was performed to describe pretreatment variables predictive for achieving a pCR. With a median follow-up of 6.4 years (range 0-10.4), only grading retained its independent impact on DFS, DDFS and OS [hazard ratio (HR) 1.5, 1.7 and 2.9, respectively; p<0.05] after adjusting for the strongest independent prognostic factors pathological T category at surgery (HR 1.6, 1.8 and 1.7, respectively; p<0.001) and pathological N category at surgery (HR 2.3, 2.4 and 2.1, respectively; p<0.001). Predictive factors for the achievement of pCR (p<0.05) were age under 35 years, lower stage or smaller clinical tumor size and higher expression of Bcl-2 at diagnosis. We conclude that only grading retained its independent prognostic impact on DFS, DDFS and OS after adjusting for pathological response of breast tumor and axillary lymph node metastases to preoperative chemotherapy. According to our data, it could be hypothesized that young patients with early tumor stage and small primary tumors might profit most from preoperative chemotherapy.
authors.affiliation: Department of Gynecology and Obstetrics, University of Heidelberg, Vossstrasse 9, 69115 Heidelberg, Germany. andreas.schneeweiss@med.uni-heidelberg.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Schneeweiss
authors.forename: Julia
authors.initials: J
authors.lastname: Katretchko
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Sinn
authors.forename: Kristina
authors.initials: K
authors.lastname: Unnebrink
authors.forename: Christian
authors.initials: C
authors.lastname: Rudlowski
authors.forename: Matthias
authors.initials: M
authors.lastname: Geberth
authors.forename: Frank
authors.initials: F
authors.lastname: Beldermann
authors.forename: Gunther
authors.initials: G
authors.lastname: Bastert
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Strittmatter
mesh_terms: D000328:Adult; D018943:Anthracyclines / Q000008:administration & dosage / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000145:classification / Q000188:drug therapy / Q000235:genetics*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D015870:Gene Expression / Q000235:genetics; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D012074:Remission Induction; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018943:Anthracyclines