title: Utility of the CPS+EG staging system in hormone receptor-positive, human epidermal growth factor receptor 2-negative breast cancer treated with neoadjuvant chemotherapy.
abstract: BACKGROUND
  Pathologic complete response after neoadjuvant chemotherapy (NACT) correlates with overall survival (OS) in primary breast cancer. A recently described staging system based on pre-treatment clinical stage (CS), final pathological stage (PS), estrogen receptor (ER) status and nuclear grade (NG) leads to a refined estimation of prognosis in unselected patients. Its performance in luminal type breast cancers has not been determined. This study investigates the clinical utility of this CPS+EG score when restricted to hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) patients and compares the results to a cohort of unselected patients.
  
  
  METHODS
  The CPS+EG score was calculated for 6637 unselected patients and 2454 patients with HR+/HER2- tumours who received anthracycline/taxane-based NACT within 8 prospective German trials.
  
  
  RESULTS
  Five-year disease-free survival (DFS) and OS were 75.6% and 84.1% for the unselected cohort and 80.6% and 87.8% for the HR+/HER2- subgroup, respectively. The CPS+EG system distinguished different prognostic groups with 5-year DFS ranging from 0% to 91%. The CPS+EG system leads to an improved categorisation of patients by outcome compared to CS, PS, ER or NG alone. When applying the CPS+EG score to the HR+/HER2- subgroup, a shift to lower scores was observed compared to the overall population, but 5-year DFS and OS for the individual scores were identical to that observed in the overall population.
  
  
  CONCLUSIONS
  In HR+/HER2- patients, the CPS+EG staging system retains its ability to facilitate a refined stratification of patients according to outcome. It can help to select candidates for post-neoadjuvant clinical trials in luminal breast cancer.
authors.affiliation: Nationales Centrum für Tumorerkrankungen (NCT), Heidelberg, Im Neuenheimer Feld 460, 69120 Heidelberg, Germany; Universitäts-Frauenklinik Heidelberg, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany. Electronic address: frederik.marme@med.uni-heidelberg.de.
authors.forename: Frederik
authors.initials: F
authors.lastname: Marmé
authors.affiliation: German Breast Group (GBG) Forschungs GmbH, Martin Behaim Strasse 12, 63263 Neu-Isenburg, Germany.
authors.forename: Bianca
authors.initials: B
authors.lastname: Lederer
authors.affiliation: Sankt Gertrauden Krankenhaus, Paretzer Straße 12, 10713 Berlin, Germany.
authors.forename: Jens-Uwe
authors.initials: JU
authors.lastname: Blohmer
authors.affiliation: Universitäts-Frauenklinik Magdeburg, Gerhart-Hauptmann-Straße 35, 39108 Magdeburg, Germany.
authors.forename: Serban Dan
authors.initials: SD
authors.lastname: Costa
authors.affiliation: Institute of Pathology, Charité-Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Denkert
authors.affiliation: Universitäts-Frauenklinik Kiel, Michaelisstraße 16, 24105 Kiel, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Eidtmann
authors.affiliation: Universitäts-Frauenklinik Rostock, Südring 81, 18059 Rostock, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Gerber
authors.affiliation: Klinikum zum Roten Kreuz, Nymphenburger Straße 163, 80634 München, Germany.
authors.forename: Claus
authors.initials: C
authors.lastname: Hanusch
authors.affiliation: Eilenriede Krankenhaus, Uhlemeyerstraße 16, 30175 Hannover, Germany.
authors.forename: Jörn
authors.initials: J
authors.lastname: Hilfrich
authors.affiliation: Universitäts-Frauenklinik Ulm, Prittwitzstraße 43, 89081 Ulm, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Huober
authors.affiliation: Klinikum Offenbach, Starkenburgring 66, 63069 Offenbach, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Jackisch
authors.affiliation: Brustzentrum, Kliniken Essen-Mitte, Henricistr. 92, 45136 Essen, Germany.
authors.forename: Sherko
authors.initials: S
authors.lastname: Kümmel
authors.affiliation: German Breast Group (GBG) Forschungs GmbH, Martin Behaim Strasse 12, 63263 Neu-Isenburg, Germany.
authors.forename: Sibylle
authors.initials: S
authors.lastname: Loibl
authors.affiliation: Universitäts-Frauenklinik rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 München, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Paepke
authors.affiliation: Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125 Berlin, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Untch
authors.affiliation: German Breast Group (GBG) Forschungs GmbH, Martin Behaim Strasse 12, 63263 Neu-Isenburg, Germany.
authors.forename: Gunter
authors.initials: G
authors.lastname: von Minckwitz
authors.affiliation: Nationales Centrum für Tumorerkrankungen (NCT), Heidelberg, Im Neuenheimer Feld 460, 69120 Heidelberg, Germany; Universitäts-Frauenklinik Heidelberg, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Schneeweiss
mesh_terms: D000328:Adult; D000368:Aged; D018943:Anthracyclines / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D002986:Clinical Trials as Topic; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D043823:Taxoids / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D018943:Anthracyclines; D043823:Taxoids
keywords: Breast cancer; CPS+EG score; HER2 negative; Hormone-receptor positive; Neoadjuvant chemotherapy; Pathologic complete response; Prognosis