The Clinicopathological Predictive Factors of a Therapeutic Effect with Preoperative Neoadjuvant Chemotherapy for Locally Advanced Breast Cancers.
Tomonori Kawasaki, Tetsuo Kondo, Hideko Yamauchi, Tadao Nakazawa, Tetsu Yamane, Kunio Mochizuki, Osamu Takahashi, Hiroshi Yagata, Hiroko Tsunoda, Seigo Nakamura, Takanori Maruyama, Ayako Inoue, Masayuki Inoue, Shingo Inoue, Koji Kono, Hideki Fujii, Ryohei Katoh. University of Yamanashi, Japan; St. Luke's International Hospital, Tokyo, Japan
Background: Neoadjuvant chemotherapy (NAC) is the standard of care for patients with locally advanced breast cancer, and it is being used increasingly with operable breast cancer. In this study, we analyzed how the clinicopathological parameters obtained from pre-NAC needle biopsy can predict the chemotherapeutic effect on invasive breast carcinomas.
Design: Primary breast carcinomas (165 cases) having a 3 cm or greater invasive tumor size and/or with axillary lymph node metastasis received NAC (5-fluorouracil-epirubicin-cyclophosphamide followed by docetaxel) and subsequent surgical resection. We investigated the association between the histological NAC effects using Japanese Breast Cancer Society assessment criteria and the clinicopathological factors of the pre-NAC needle biopsy. Factors included nuclear atypia (NA), mitotic index (MI), nuclear grade (NG), histological grade (HG), proliferative pattern (papillotubular, solid or trabecular) and size of cancer cell nests, degree of lymphocyte infiltration, cancer cells' metaplastic, lobular or neuroendocrine features, estrogen receptor (ER) and progesterone receptor (PgR) immunoreactivities and HER2.
Results: There was no histological effect in 13 cases (8%), mild in 57 cases (35%), moderate in 46 cases (28%), marked in 37 cases (22%) and complete in 12 cases (7%). The clinicopathological features seen in the tumor groups having a greater response to NAC were high MI, high NG, high HG, solid architectural pattern and large size of cancer cell nests, marked lymphocyte infiltrate, negativity for ER/PgR and over expression of HER2 (P<0.05). Paradoxically, we saw similar histopathological results in 9 (5%) of the 13 cases that had tumor enlargement and no effect from NAC, i.e. high MI, high NG, high HG, solid growth pattern and large size of cancer cell nests, and nonreactivity for ER/PgR. However, these 9 cases were negative for HER2, with metaplastic changes including spindle cell features and squamous differentiation in 4 cases and/or a high NA in 3 cases.
Conclusions: Pre-NAC needle biopsy specimens for locally advanced breast cancers include many predictive pathological factors for NAC efficiency which may be helpful for NAC case selection and follow-up care. Although NAC was generally more effective for high-grade tumor groups, tumor enlargement during NAC also occurred in some of these groups, particularly in the triple negative (ER-/PgR-/HER2-) cancers, including metaplastic and/or undifferentiated carcinomas.
Tuesday, March 1, 2011 9:30 AM
Poster Session III # 40, Tuesday Morning