T. J. Stankowski-Drengler1, J. Schumacher1, B. Hanlon1, D. Livingston-Rosanoff1, K. Vande Walle1, C. C. Greenberg1, L. G. Wilke1, H. B. Neuman1 1University Of Wisconsin,General Surgery,Madison, WI, USA
Introduction: Prior studies have demonstrated variations in rates of pathologic complete response (pCR) after neoadjuvant chemotherapy based on receptor status, with an association between pCR and survival for most receptor types. Fewer studies have examined survival and recurrence based on receptor status for women undergoing neoadjuvant chemotherapy who do not experience a pCR. Our objective was to evaluate differences in survival and distant recurrence for patients with residual stage II/III breast cancer following neoadjuvant chemotherapy by receptor type.
Methods: A stage-stratified random sample of 11,360 patients with stage II-III breast cancer in 2006-2007 was selected from 1217 facilities in the National Cancer Database (NCDB) for a Commission on Cancer Special Study. We identified patients with residual pathologic stage II/III cancer after neoadjuvant chemotherapy. We excluded patients who did not receive standard of care therapy based on receptor status (i.e. endocrine therapy and/or Her2neu therapy). Medical record abstraction included distant recurrence as well as survival for 5 years post-diagnosis. Kaplan-Meier estimation was used to generate survival curves after neoadjuvant chemotherapy by receptor status.
Results: Our analytic cohort included 736 patients with residual disease after neoadjuvant chemotherapy. 58% of patients had ER or PR+/Her2neu- disease, 28% had ER and PR-/Her2neu- (triple negative) disease, and 14% had Her2neu+ (any ER/PR) disease. Median follow-up time was 7.2 years (0.6-9.4). Patients with triple negative cancer had the poorest 5-year overall survival (52% vs 82% Her2neu+ and ER or PR+/Her2neu-), and distant recurrence free survival (57% vs 72% Her2neu+ and 77% ER or PR+/Her2neu-) (Figure 1).
Conclusion: Patients with triple negative cancer who have residual disease after neoadjuvant chemotherapy have a significant risk of distant recurrence and mortality, when compared to patients with other breast cancer types. The relatively poor outcomes for patients with residual triple negative disease supports the consideration of additional adjuvant therapy as well as novel clinical trials for patients with triple negative with residual disease post-neoadjuvant chemotherapy. These data can be used by clinicians to counsel their patients regarding prognosis, specifically the relatively favorable prognosis for patients with options for targeted therapy in the face of residual disease.
