title: Clinical and pathological predictors of the response to neoadjuvant anthracycline chemotherapy in locally advanced breast cancer.
abstract: OBJECTIVE
  The aim of this study is to determine clinical and histopathological characteristics correlated to responsiveness to anthracycline-based neoadjuvant chemotherapy in breast cancer.
  
  
  METHODS
  We studied primary tumor specimens with local advanced breast cancer from 40 patients. Patients received anthracycline-based chemotherapy. Neoadjuvant regimen consisted in 600 mg/m2 5-fluorouracil, 60 mg/m2 doxorubicin, and 600 mg/m2 cyclophosphamide (FAC). The World Health Organization criteria were used to classify the tumors. We performed immunohistochemical staining for ER, PgR, HER-2, PCNA (proliferation cell nuclear antigen), Ki-67, p53, and Bcl-2. Clinical and histopathological characteristics were associated with clinical response and histopathological changes induced by chemotherapy.
  
  
  RESULTS
  The mean age was 47 +/- 14 yr. Twenty-three percent of patients were in stage IIB and 77% were in stages IIIA and IIIB. Seven percent of patients had progression of the disease. Stable disease was observed in 42% of patients and 45% had partial response. Only 7% of patients had a complete response. Factors associated with a better and major percentage of clinical response were the administration of doxorubicin-based chemotherapy, administration of more than three cycles, clinical N1, atypia, more than 10 mitosis per high-power field, moderate to severe SBR grade, and a major index of cellular proliferation.
  
  
  CONCLUSIONS
  We found that tumors with large volumes, N2 node status, low cellular proliferation rate, positive immunoreactivity to p53, and low differentiation grade have a lower response to neoadjuvant chemotherapy with anthracycline. These patients could benefit from a different chemotherapy scheme to obtain a better control and resection.
authors.affiliation: Department of Hemato-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición, Mexico.
authors.forename: Mónica
authors.initials: M
authors.lastname: Fernández-Sánchez
authors.forename: Armando
authors.initials: A
authors.lastname: Gamboa-Dominguez
authors.forename: Norma
authors.initials: N
authors.lastname: Uribe
authors.forename: Ana Cristina
authors.initials: AC
authors.lastname: García-Ulloa
authors.forename: Diana
authors.initials: D
authors.lastname: Flores-Estrada
authors.forename: Myrna
authors.initials: M
authors.lastname: Candelaria
authors.forename: Oscar
authors.initials: O
authors.lastname: Arrieta
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D014408:Biomarkers, Tumor / Q000378:metabolism*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000378:metabolism* / Q000473:pathology; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D007150:Immunohistochemistry; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009363:Neoplasm Proteins / Q000378:metabolism*; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D047368:Tumor Burden
chemical_list: D014408:Biomarkers, Tumor; D009363:Neoplasm Proteins; D004317:Doxorubicin; D003520:Cyclophosphamide; D005472:Fluorouracil