title: Correlation between response to neoadjuvant chemotherapy and survival in locally advanced breast cancer patients.
abstract: BACKGROUND
  Measurement of residual disease following neoadjuvant chemotherapy that accurately predicts long-term survival in locally advanced breast cancer (LABC) is an essential requirement for clinical trials development. Several methods to assess tumor response have been described. However, the agreement between methods and correlation with survival in independent cohorts has not been reported.
  
  
  METHODS
  We report survival and tumor response according to the measurement of residual breast cancer burden (RCB), the Miller and Payne classification and the Response Evaluation Criteria in Solid Tumors (RECIST) criteria, in 151 LABC patients. Kappa Cohen's coefficient (К) was used to test the agreement between methods. We assessed the correlation between the treatment outcome and overall survival (OS) and relapse-free survival (RFS) by calculating Harrell's C-statistic (c).
  
  
  RESULTS
  The agreement between Miller and Payne classification and RCB classes was very high (К = 0.82). In contrast, we found a moderate-to-fair agreement between the Miller and Payne classification and RECIST criteria (К = 0.52) and RCB classes and RECIST criteria (К = 0.38). The adjusted C-statistic to predict OS for RCB index (0.77) and RCB classes (0.75) was superior to that of RECIST criteria (0.69) (P = 0.007 and P = 0.035, respectively). Also, RCB index (c = 0.71), RCB classes (c = 0.71) and Miller and Payne classification (c = 0.67) predicted better RFS than RECIST criteria (c = 0.61) (P = 0.005, P = 0.006 and P = 0.028, respectively).
  
  
  CONCLUSIONS
  The pathological assessment of tumor response might provide stronger prognostic information in LABC patients.
authors.affiliation: Medical Oncology Department, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos, 28040 Madrid.
authors.forename: A
authors.initials: A
authors.lastname: Romero
authors.forename: J A
authors.initials: JA
authors.lastname: García-Sáenz
authors.forename: M
authors.initials: M
authors.lastname: Fuentes-Ferrer
authors.forename: J A
authors.initials: JA
authors.lastname: López Garcia-Asenjo
authors.forename: V
authors.initials: V
authors.lastname: Furió
authors.forename: J M
authors.initials: JM
authors.lastname: Román
authors.forename: A
authors.initials: A
authors.lastname: Moreno
authors.forename: M
authors.initials: M
authors.lastname: de la Hoya
authors.forename: E
authors.initials: E
authors.lastname: Díaz-Rubio
authors.forename: M
authors.initials: M
authors.lastname: Martín
authors.forename: T
authors.initials: T
authors.lastname: Caldés
mesh_terms: D000328:Adult; D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D000077143:Docetaxel; D004317:Doxorubicin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D016016:Proportional Hazards Models; D043823:Taxoids / Q000627:therapeutic use*; D016896:Treatment Outcome; D047368:Tumor Burden
chemical_list: D000903:Antibiotics, Antineoplastic; D043823:Taxoids; D000077143:Docetaxel; D004317:Doxorubicin