Lu Cao, MD
No relationships to disclose.
PD 17 - Breast 4 -Poster Discussion
Purpose/Objective(s): Following neoadjuvant chemotherapy (NAC), the optimal strategies for regional nodal irradiation (RNI) are currently under active investigation, especially in patients with cN1 and ypN0-1. The Neo-Bioscore staging system has shown promising prospect in assessing prognosis after NAC. In this analysis, we evaluate the role of Neo-Bioscore staging system in guiding RNI following NAC in patients with cN1 and ypN0-1.
Materials/Methods: Consecutive women with pretreatment cN1, who received NAC with post-treatment pN0 or pN1 between 2009 and 2014 from single center were retrospectively reviewed. According to the report by Mittendorf et al, the Neo-Bioscore staging system consists of three parts: pretreatment clinical stage, post-treatment pathologic stage, and tumor marker (estrogen receptor, HER2 and histological grade). Each part has an assigned point to a total summed point. A pathologic complete response (pCR) is defined as no invasive disease in the breast or regional lymph nodes after surgery.
Results: One hundred and sixty-three patients were enrolled in this study, including 18 patients received breast conserving surgery. Of the 163 patients, 119 (73%) received RNI. At surgery, 36 patients (22.1%) achieved pCR, while 89 patients (54.6%) achieved ypN0. The median follow-up was 59.4 months (rang: 16-106). In the whole cohort, RNI was associated with slightly improved outcome, with a 5-year locoregional recurrence free survival (LRRFS) rate of 98.6% vs. 95.7% (P=0.393), a regional recurrence free survival (RRFS) rate of 98% vs. 97.7% (P=0.865), a 5-year distant-recurrence free survival (DRFS) rate of 91.6% vs. 83.4% (P=0.052), a 5-year recurrence free survival (RFS) rate of 90.9% vs. 87.4% (P=0.43), and a 5-year breast cancer specific free survival (BCSFS) rate of 98% vs. 91.9% (P=0.097) in the RNI and Non-RNI group, respectively. In the subgroup of patients with Neo-Bioscore of 1 to 3 (n=92), RNI significantly increased 5-year DRFS rate of 97% vs. 76.9% (P=0.002), 5-year RFS rate of 95.5% vs. 76.9% (P=0.007) and 5-year BCSFS rate of 100% vs. 89.2% (P=0.005). While no significant difference in outcome was found between RNI and non-RNI group in patients with Neo-Bioscore of 4 to 6 (n=71). In patients with any Neo-Bioscore, RNI is associated with a significantly improved DRFS (both P<0.05) in those not achieving pCR or with ypN+.
Conclusion: As the Neo-Bioscore staging system provides more comprehensive information in patients receiving NAC, including initial disease burden, response to NAC and biomarker for systemic therapy, it has the potential to better identify patients with cN1 and ypN0-1 who may benefit from RNI following NAC in addition to the established clinical and pathological parameters.
No relationships to disclose.
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