title: Prognostic Impact of Residual Disease After Neoadjuvant Chemotherapy in 648 Patients with Triple-negative Breast Cancer.
abstract: OBJECTIVE
  In order to establish a new risk categorization system for triple-negative breast cancer (TNBC) after neoadjuvant chemotherapy, we analyzed a large database including more than 50% of all breast cancer cases nationwide.
  
  
  METHODS
  From a database of 39,570 primary breast cancer cases, 648 patients with TNBC were treated with neoadjuvant chemotherapy (2009-2011). The primary study end-point was the impact of residual tumor burden on survival.
  
  
  RESULTS
  Pathological complete response (pCR) was achieved in 199 patients; 449 patients had a non-pCR (pCR rate=30.8%). Stage ypT1 did not differ prognostically from ypT2, and likewise ypT3 not from ypT4 (in patients with N0 and N1-3 disease). Combined analysis of ypT1/2 and ypT3/4 yielded highly significant differences (p=0.000145).
  
  
  CONCLUSIONS
  A partial response still conveys a substantial survival benefit. There is no linear deterioration of prognosis according to residual tumor size. Post-neoadjuvant TNM stages ypT1 and ypT2, and ypT3 and ypT4 pairwise build uniform prognostic groups in TNBC, when there is no or low axillary lymph-node involvement.
authors.affiliation: Women's Department, West German Cancer Center, University of Duisburg-Essen, University Hospital of Essen, Essen, Germany Peter.Kern@uk-essen.de.
authors.forename: Peter
authors.initials: P
authors.lastname: Kern
authors.affiliation: German Breast Group, Neu-Isenburg, Germany.
authors.forename: Gunter
authors.initials: G
authors.lastname: Von Minckwitz
authors.affiliation: Institute for Medical Informatics, Biometry and Epidemiology, Essen, Germany.
authors.forename: Carolin
authors.initials: C
authors.lastname: Puetter
authors.affiliation: Women's Department, West German Cancer Center, University of Duisburg-Essen, University Hospital of Essen, Essen, Germany.
authors.forename: Sofia
authors.initials: S
authors.lastname: Pavlidou
authors.affiliation: Women's Department, West German Cancer Center, University of Duisburg-Essen, University Hospital of Essen, Essen, Germany.
authors.forename: Annika
authors.initials: A
authors.lastname: Flach
authors.affiliation: Women's Department, West German Cancer Center, University of Duisburg-Essen, University Hospital of Essen, Essen, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Kimmig
authors.affiliation: European Breast Center, Düsseldorf, Germany.
authors.forename: Mahdi
authors.initials: M
authors.lastname: Rezai
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D016208:Databases, Factual; D005260:Female; D006801:Humans; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D011446:Prospective Studies; D016019:Survival Analysis; D064726:Triple Negative Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology*
keywords: Triple-negative breast cancer; neoadjuvant chemotherapy; pCR; pathological complete response; prognostic impact; residual disease