title: Different Prognostic Implications of Residual Disease After Neoadjuvant Treatment: Impact of Ki 67 and Site of Response.
abstract: Pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) can be used as an independent prognostic factor in neoadjuvant trials. The objective of this study was to determine the impact of Ki 67 expression and site of response on overall survival (OS) and disease-free survival (DFS) across different molecular subtypes of breast cancer following NAC.
  
  
  
  Records from 357 patients who received NAC from 2004 to 2011 were reviewed. Univariate and multivariate analyses were performed to analyze clinical and pathological factors that influence pCR and DFS.
  
  
  
  Mean follow-up time was 45 months (range 12-112). pCR was achieved in 82 patients (23 %). According to molecular subtypes, rates of pCR were significantly higher for patients with HER2-positive and triple-negative tumors (69.4 and 32.7 %, respectively; p < 0.001) compared with other molecular subtypes. pCR was a predictive factor of longer OS and DFS. The hazard ratio for DFS in patients with positive lymph nodes (ypN1) after NAC was 2.48 (95 % confidence interval 1.47-4.19). Multivariate analysis showed that molecular subtype, changes in Ki 67 expression, and axillary lymph node response were significantly predictors of OS and DFS.
  
  
  
  pCR in the axilla and posttreatment changes in Ki 67 after NAC are associated with improved survival. Depending on axillary staging before NAC, detection of minimal residual disease-defined as the presence of isolated tumor cells in the SLN after NAC-may confer different prognosis. Further studies are needed to tailor treatments for patients with residual disease after NAC.
authors.affiliation: Breast Surgical Oncology Unit, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Diaz-Botero
authors.affiliation: Breast Surgical Oncology Unit, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Martin
authors.initials: M
authors.lastname: Espinosa-Bravo
authors.affiliation: Breast Surgical Oncology Unit, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Victor Rodrigues
authors.initials: VR
authors.lastname: Gonçalves
authors.affiliation: Breast Surgical Oncology Unit, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Esgueva-Colmenarejo
authors.affiliation: Pathology Department, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Peg
authors.affiliation: Department of Medical Oncology, Hospital Universitario Vall d'Hebron, Barcelona, Spain.|Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Perez
authors.affiliation: Department of Medical Oncology, Hospital Universitario Ramón y Cajal, Madrid, Spain.|Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Cortes
authors.affiliation: Breast Surgical Oncology Unit, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain. irubio@vhio.net.
authors.forename: Isabel T
authors.initials: IT
authors.lastname: Rubio
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001365:Axilla; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019394:Ki-67 Antigen / Q000378:metabolism*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000378:metabolism*; D018365:Neoplasm, Residual; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism; D015996:Survival Rate; D064726:Triple Negative Breast Neoplasms / Q000378:metabolism* / Q000473:pathology*; D047368:Tumor Burden
chemical_list: D000970:Antineoplastic Agents; D019394:Ki-67 Antigen; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; C508053:ERBB2 protein, human