Prognosis After Pathologic Complete Response to Neoadjuvant Therapy in Early-Stage Breast Cancer: A Population-Based Study.

IF 14.8 2区 医学 Q1 ONCOLOGY Journal of the National Comprehensive Cancer Network Pub Date : 2025-03-12 DOI:10.6004/jnccn.2024.7093
Caroline Boman, Christian Tranchell, Xingrong Liu, Louise Eriksson Bergman, Maria Angeliki Toli, Jonas Bergh, Theodoros Foukakis, Alexios Matikas
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Abstract

Background: Pathologic complete response (pCR) following neoadjuvant chemotherapy (NACT) for early-stage breast cancer is prognostic, but not the sole surrogate marker for long-term outcome at a trial level, given that recurrence risk persists in patients who achieve pCR. This study aimed to investigate factors affecting the outcome of patients who achieve pCR.

Methods: This population-based cohort study prospectively enrolled patients who received NACT for nonmetastatic breast cancer between 2007 and 2020 in the Stockholm-Gotland region, which comprises 25% of the entire Swedish population. The primary endpoint was distant relapse-free survival (DRFS), defined as time from surgery to distant recurrence or death from any cause.

Results: Median follow-up from surgery was 5.9 years. Among 2,487 patients, 661 (26.6%) attained pCR. Several factors were independently associated with DRFS in patients with pCR, including increasing age (adjusted hazard ratio [aHR], 1.04; 95% CI, 1.01-1.06), T3/T4 stage (aHR, 2.02; 95% CI, 1.05-3.87), and HER2 positivity (aHR, 0.34; 95% CI, 0.17-0.68). Node positivity predicted distant recurrence during the first year postsurgery (aHR, 2.84; 95% CI, 1.16-6.94), whereas estrogen receptor positivity predicted distant recurrence at 5 to 10 years (aHR, 4.30; 95% CI, 1.06-17.49). The rate of central nervous system relapse as the first site of recurrence was not affected by pCR status (5.3% vs 4.1%; P=.21).

Conclusions: In this population-based study, our findings suggest that patients achieving pCR after NACT are a heterogeneous group in terms of long-term prognosis. Baseline tumor characteristics should be considered when investigating post-neoadjuvant therapy approaches.

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CiteScore
20.20
自引率
0.00%
发文量
388
审稿时长
4-8 weeks
期刊介绍: JNCCN—Journal of the National Comprehensive Cancer Network is a peer-reviewed medical journal read by over 25,000 oncologists and cancer care professionals nationwide. This indexed publication delivers the latest insights into best clinical practices, oncology health services research, and translational medicine. Notably, JNCCN provides updates on the NCCN Clinical Practice Guidelines in Oncology® (NCCN Guidelines®), review articles elaborating on guideline recommendations, health services research, and case reports that spotlight molecular insights in patient care. Guided by its vision, JNCCN seeks to advance the mission of NCCN by serving as the primary resource for information on NCCN Guidelines®, innovation in translational medicine, and scientific studies related to oncology health services research. This encompasses quality care and value, bioethics, comparative and cost effectiveness, public policy, and interventional research on supportive care and survivorship. JNCCN boasts indexing by prominent databases such as MEDLINE/PubMed, Chemical Abstracts, Embase, EmCare, and Scopus, reinforcing its standing as a reputable source for comprehensive information in the field of oncology.
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