title: Prognostic factors in operable breast cancer treated with neoadjuvant chemotherapy: towards a quantification of residual disease.
abstract: OBJECTIVE
  Neoadjuvant chemotherapy (NACT) allows for a more frequent use of breast-conservative surgery; it is also an in vivo model of individual tumor sensitivity which permits to determine new prognostic factors to personalize the therapeutic approach.
  
  
  METHODS
  Between 2000 and 2012, 318 patients with primary invasive breast cancer were treated with a median of 6 cycles of NACT; they received either an anthracycline-based FEC 100 protocol (31.1%), or anthracyclines + taxanes (53.5%), with trastuzumab if indicated (15.4%).
  
  
  RESULTS
  After a median follow-up of 44.2 months, the pathological complete response rate according to the classification of Chevallier et al. [Am J Clin Oncol 1993;16:223-228] was 19.3%, and overall (OS) and disease-free survival (DFS) at 10 years were 60.2 and 69.6%, respectively. Univariate analyses demonstrated that the Residual Disease in Breast and Nodes (RDBN) index was the most significant prognostic factor for OS (p = 0.0082) and DFS (p = 0.0022), and multivariate analyses mainly revealed that the residual tumor size, residual involved node number and post-chemotherapy Scarff-Bloom-Richardson (SBR) grading were the most significant prognostic factors.
  
  
  CONCLUSIONS
  In a cohort of patients who were all homogeneously treated with some of the most common drugs for breast cancer, we demonstrate that NACT may provide additional prognostic factors and confirm the RDBN index. As this index allows for the prediction of survival with different breast cancer subtypes, we suggest that it should be calculated routinely to help clinicians to select patients who need adjuvant treatments.
authors.affiliation: Department of Clinical Research, Jean Godinot Institute, Reims, France.
authors.forename: Sarah
authors.initials: S
authors.lastname: Mombelli
authors.forename: Fabrice
authors.initials: F
authors.lastname: Kwiatkowski
authors.forename: Catherine
authors.initials: C
authors.lastname: Abrial
authors.forename: Qian
authors.initials: Q
authors.lastname: Wang-Lopez
authors.forename: Paul
authors.initials: P
authors.lastname: de Boissieu
authors.forename: Christian
authors.initials: C
authors.lastname: Garbar
authors.forename: Armand
authors.initials: A
authors.lastname: Bensussan
authors.forename: Hervé
authors.initials: H
authors.lastname: Curé
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018943:Anthracyclines / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy* / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D015986:Confounding Factors, Epidemiologic; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D015412:Mastectomy, Segmental; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000453:epidemiology*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D043823:Taxoids / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D018943:Anthracyclines; D043823:Taxoids; D015251:Epirubicin; D003520:Cyclophosphamide; D005472:Fluorouracil