Journal of Clinical Oncology, Vol 16, 107-114, Copyright © 1998 by American Society of Clinical Oncology
Clinical prognostic and predictive factors for primary chemotherapy in operable breast cancer
P Ellis, I Smith, S Ashley, G Walsh, S Ebbs, M Baum, N Sacks and J McKinna
Breast Unit, Royal Marsden Hospital, London, United Kingdom.
PURPOSE: This study aimed to identify clinical factors that are of
prognostic significance or that predict for subsequent treatment outcome in
patients with large operable breast cancer treated with primary
chemotherapy (PCT) at our institution. METHODS: One hundred eighty-five
patients received the following regimens: CMF or MMM (76 patients), ECF (75
patients), AC or FEC (34 patients), followed by surgery, with radiotherapy
(RT) given to those with breast conservation. A number of common clinical
variables were assessed in relation to local recurrence-free survival
(LRFS), disease-free survival (DFS), and overall survival (OS). RESULTS:
Clinical responders had improved DFS (P = .009) and OS (P = .08) compared
with nonresponders. There was no association between clinical or pathologic
complete remission (CR) and survival. Pretreatment clinical axillary node
positivity was a significant predictor of worsened DFS (P = .0001), OS (P =
.0001), and LRFS (P = .03). Patients remaining clinically node-positive
postchemotherapy had an inferior outcome compared with those becoming
node-negative (DFS, P = .03; OS, P = .03) but pathologic axillary node
status was not shown to predict for survival. Twenty-nine patients in
clinical CR following PCT who electively did not have surgery and were
treated with RT alone had significantly increased local recurrence rate
compared with partial responders having surgery and RT (P = .02). There
were no differences in DFS or OS between these groups. On multivariate
analysis, clinical axillary node status was the only independent predictor
of OS and DFS, and LRFS. CONCLUSION: Pretreatment and posttreatment
clinical axillary node status is a major predictor of outcome following
PCT. Complete clinical response does not define a more favorable subgroup
compared with those not obtaining CR.
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