title: Outcome after neoadjuvant chemotherapy in Asian breast cancer patients.
abstract: We aim to identify clinicopathologic predictors for response to neoadjuvant chemotherapy and to evaluate the prognostic value of pathologic complete response (pCR) on survival in Asia. This study included 915 breast cancer patients who underwent neoadjuvant chemotherapy at five public hospitals in Singapore and Malaysia. pCR following neoadjuvant chemotherapy was defined as 1) no residual invasive tumor cells in the breast (ypT0/is) and 2) no residual invasive tumor cells in the breast and axillary lymph nodes (ypT0/is ypN0). Association between pCR and clinicopathologic characteristics and treatment were evaluated using chi-square test and multivariable logistic regression. Kaplan-Meier analysis and log-rank test, stratified by other prognostic factors, were conducted to compare overall survival between patients who achieved pCR and patients who did not. Overall, 4.4% of nonmetastatic patients received neoadjuvant chemotherapy. The median age of preoperatively treated patients was 50 years. pCR rates were 18.1% (pCR ypT0/is) and 14.4% (pCR ypT0/is ypN0), respectively. pCR rate was the highest among women who had higher grade, smaller size, estrogen receptor negative, human epidermal growth factor receptor 2-positive disease or receiving taxane-based neoadjuvant chemotherapy. Patients who achieved pCR had better overall survival than those who did not. In subgroup analysis, the survival advantage was only significant among women with estrogen receptor-negative tumors. Patients with poor prognostic profile are more likely to achieve pCR and particularly when receiving taxane-containing chemotherapy. pCR is a significant prognostic factor for overall survival especially in estrogen receptor-negative breast cancers.
authors.affiliation: Department of Surgery, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
authors.forename: Li Yan
authors.initials: LY
authors.lastname: Lim
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, Singapore, 117549, Singapore.
authors.forename: Hui
authors.initials: H
authors.lastname: Miao
authors.affiliation: Department of Hematology Oncology, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
authors.forename: Joline S J
authors.initials: JS
authors.lastname: Lim
authors.affiliation: Department of Hematology Oncology, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
authors.forename: Soo Chin
authors.initials: SC
authors.lastname: Lee
authors.affiliation: Julius Centre University Malaya, Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia.
authors.forename: Nirmala
authors.initials: N
authors.lastname: Bhoo-Pathy
authors.affiliation: Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia.
authors.forename: Cheng Har
authors.initials: CH
authors.lastname: Yip
authors.affiliation: Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia.
authors.forename: Nur Aishah B M
authors.initials: NA
authors.lastname: Taib
authors.affiliation: Department of Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
authors.forename: Patrick
authors.initials: P
authors.lastname: Chan
authors.affiliation: Department of Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
authors.forename: Ern Yu
authors.initials: EY
authors.lastname: Tan
authors.affiliation: Breast Department, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
authors.forename: Swee Ho
authors.initials: SH
authors.lastname: Lim
authors.affiliation: Breast Department, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
authors.forename: Geok Hoon
authors.initials: GH
authors.lastname: Lim
authors.affiliation: Breast Department, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
authors.forename: Evan
authors.initials: E
authors.lastname: Woo
authors.affiliation: Breast Department, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
authors.forename: Yia Swam
authors.initials: YS
authors.lastname: Tan
authors.affiliation: Breast Department, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
authors.forename: Jung Ah
authors.initials: JA
authors.lastname: Lee
authors.affiliation: Department of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore.
authors.forename: Mabel
authors.initials: M
authors.lastname: Wong
authors.affiliation: Department of Pathology, Singapore General Hospital, 20 College Road, Singapore, 169856, Singapore.
authors.forename: Puay Hoon
authors.initials: PH
authors.lastname: Tan
authors.affiliation: Division of Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore.
authors.forename: Kong Wee
authors.initials: KW
authors.lastname: Ong
authors.affiliation: Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore.
authors.forename: Fuh Yong
authors.initials: FY
authors.lastname: Wong
authors.affiliation: Breast Department, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.|Department of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore.
authors.forename: Yoon Sim
authors.initials: YS
authors.lastname: Yap
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, Singapore, 117549, Singapore.|Department of Surgery, National University of Singapore and National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
authors.forename: Mikael
authors.initials: M
authors.lastname: Hartman
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy* / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008296:Malaysia; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D060787:Neoplasm Grading; D011379:Prognosis; D012846:Singapore; D016019:Survival Analysis; D043823:Taxoids / Q000008:administration & dosage* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D043823:Taxoids
keywords: Breast cancer; clinicopathologic predictors; neoadjuvant chemotherapy; pathologic complete response