title: Beyond Axillary Lymph Node Metastasis, BMI and Menopausal Status Are Prognostic Determinants for Triple-Negative Breast Cancer Treated by Neoadjuvant Chemotherapy.
abstract: BACKGROUND
  Triple-negative breast cancers (TNBC) are a specific subtype of breast cancers with a particularly poor prognosis. However, it is a very heterogeneous subgroup in terms of clinical behavior and sensitivity to systemic treatments. Thus, the identification of risk factors specifically associated with those tumors still represents a major challenge. A therapeutic strategy increasingly used for TNBC patients is neoadjuvant chemotherapy (NAC). Only a subset of patients achieves a pathologic complete response (pCR) after NAC and have a better outcome than patients with residual disease.
  
  
  OBJECTIVE
  The aim of this study is to identify clinical factors associated with the metastatic-free survival in TNBC patients who received NAC.
  
  
  METHODS
  We analyzed 326 cT1-3N1-3M0 patients with ductal infiltrating TNBC treated by NAC. The survival analysis was performed using a Cox proportional hazard model to determine clinical features associated with prognosis on the whole TNBC dataset. In addition, we built a recursive partitioning tree in order to identify additional clinical features associated with prognosis in specific subgroups of TNBC patients.
  
  
  RESULTS
  We identified the lymph node involvement after NAC as the only clinical feature significantly associated with a poor prognosis using a Cox multivariate model (HR = 3.89 [2.42-6.25], p<0.0001). Using our recursive partitioning tree, we were able to distinguish 5 subgroups of TNBC patients with different prognosis. For patients without lymph node involvement after NAC, obesity was significantly associated with a poor prognosis (HR = 2.64 [1.28-5.55]). As for patients with lymph node involvement after NAC, the pre-menopausal status in grade III tumors was associated with poor prognosis (HR = 9.68 [5.71-18.31]).
  
  
  CONCLUSIONS
  This study demonstrates that axillary lymph node status after NAC is the major prognostic factor for triple-negative breast cancers. Moreover, we identified body mass index and menopausal status as two other promising prognostic factors in this breast cancer subgroup. Using these clinical factors, we were able to classify TNBC patients in 5 subgroups, for which pre-menopausal patients with grade III tumors and lymph node involvement after NAC have the worse prognosis.
authors.affiliation: Department of Surgery, Institut Curie, Paris, France.|Residual Tumor and Response to Treatment Lab, Translational Research Department, Institut Curie, Paris, France.|UMR932 Immunity and Cancer, INSERM, Paris, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Bonsang-Kitzis
authors.affiliation: Department of Biostatistic, Institut Curie, Paris, France.
authors.forename: Léonor
authors.initials: L
authors.lastname: Chaltier
authors.affiliation: Department of Biostatistic, Institut Curie, Paris, France.
authors.forename: Lisa
authors.initials: L
authors.lastname: Belin
authors.affiliation: Department of Biostatistic, Institut Curie, Paris, France.
authors.forename: Alexia
authors.initials: A
authors.lastname: Savignoni
authors.affiliation: Department of Surgery, Institut Curie, Paris, France.
authors.forename: Roman
authors.initials: R
authors.lastname: Rouzier
authors.affiliation: Department of Medical Oncology, Institut Curie, Paris, France.
authors.forename: Marie-Paule
authors.initials: MP
authors.lastname: Sablin
authors.affiliation: Department of Medical Oncology, Institut Curie, Paris, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Lerebours
authors.affiliation: Department of Medical Oncology, Institut Curie, Paris, France.
authors.forename: François-Clément
authors.initials: FC
authors.lastname: Bidard
authors.affiliation: Department of Medical Oncology, Institut Curie, Paris, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Cottu
authors.affiliation: Department of Tumor Biology, Institut Curie, Paris, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Sastre-Garau
authors.affiliation: Department of Tumor Biology, Institut Curie, Paris, France.
authors.forename: Marick
authors.initials: M
authors.lastname: Laé
authors.affiliation: Department of Medical Oncology, Institut Curie, Paris, France.|Paris Descartes University, Paris, France.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Pierga
authors.affiliation: Department of Surgery, Institut Curie, Paris, France.|Residual Tumor and Response to Treatment Lab, Translational Research Department, Institut Curie, Paris, France.|UMR932 Immunity and Cancer, INSERM, Paris, France.
authors.forename: Fabien
authors.initials: F
authors.lastname: Reyal
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001365:Axilla; D015992:Body Mass Index; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy* / Q000473:pathology*; D017024:Chemotherapy, Adjuvant / Q000379:methods; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008593:Menopause / Q000502:physiology; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D011379:Prognosis; D016019:Survival Analysis; D016896:Treatment Outcome; D064726:Triple Negative Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology*
chemical_list: D000970:Antineoplastic Agents