Nottingham Clinico-Pathological Response Index (NPRI) after Neoadjuvant Chemotherapy (Neo-ACT) Accurately Predicts Clinical Outcome in Locally Advanced Breast Cancer

Article English OPEN
Abdel-Fatah, TM ; Ball, G ; Lee, AHS ; Pinder, S ; MacMilan, RD ; Cornford, E ; Moseley, PM ; Silverman, R ; Price, J ; Latham, B ; Palmer, D ; Chan, A ; Ellis, IO ; Chan, SYT (2015)

Purpose: There is a need to identify more sensitive clinico-pathological criteria to assess the response to Neo-ACT and guide subsequent adjuvant-therapy. Experimental Design: We performed a clinico-pathological assessment of 427 patients who had completed Neo-ACT for locally advanced breast cancer (LABC) with a median follow-up of 5-years. Patients were divided into a training set treated with anthracycline combination chemotherapy (AC, n=172); an internal validation set treated with AC and taxane (n=130); and an external validation set treated with AC with or without taxane (n=125). Results: A multivariate Cox regression model demonstrated the absence of fibrosis, presence of lympho-vascular invasion, and increasing number of lymph node metastases were significantly associated with short disease-free survival (DFS) and breast-cancer specific survival (BCSS, p<0.01), whilst reduction of tumour size was associated with DFS (p=0.022). Nottingham Clinico-Pathological Response Indexes (NPRIs) were calculated and four prognostic groups (NPRI-PGs) were identified. Patients in prognostic group 2 (NPRI-PG2) for DFS (n=63/172; 36.6%) and BCSS (66/172; 38.4%) have the same prognosis as those who achieved pCR (NPRI-PG1; 15%). Receiver operating characteristic (ROC) curves indicated that the NPRI outperformed the currently used prognostic factors and adding NPRI improved their performance as a predictor for both DFS (AUC=0.87) and BCSS (AUC= 0.88). Conclusions: The NPRI predicts DFS and BCSS, with a higher sensitivity than pCR. The NPRI can also improve the sensitivity and specificity of clinico-pathological response as a study end-point, for assessing response to Neo-ACT, and can serve as a valuable tool for the discovery of future predictive molecular markers.
  • References (24)
    24 references, page 1 of 3

    1. Mauri D, Pavlidis N, Ioannidis JPA: Neoadjuvant Versus Adjuvant Systemic Treatment in Breast Cancer: A Meta-Analysis. Journal of the National Cancer Institute 97:188-194, 2005

    2. Thompson AM, Moulder-Thompson SL: Neoadjuvant treatment of breast cancer. Annals of Oncology 23:x231-x236, 2012

    3. Symmans WF, Peintinger F, Hatzis C, et al: Measurement of residual breast cancer burden to predict survival after neoadjuvant chemotherapy. J Clin Oncol 25:4414-22, 2007

    4. Gralow JR, Burstein HJ, Wood W, et al: Preoperative Therapy in Invasive Breast Cancer: Pathologic Assessment and Systemic Therapy Issues in Operable Disease. Journal of Clinical Oncology 26:814-819, 2008

    5. Fan F: Evaluation and reporting of breast cancer after neoadjuvant chemotherapy. OPJ 3:58-63, 2009

    6. von Minckwitz G, Untch M, Blohmer J-U, et al: Definition and impact of pathologic complete response on prognosis after neoadjuvant chemotherapy in various intrinsic breast cancer subtypes. Journal of Clinical Oncology 30:1796-1804, 2012

    7. Schott AF, Hayes DF: Defining the Benefits of Neoadjuvant Chemotherapy for Breast Cancer. Journal of Clinical Oncology 30:1747-1749, 2012

    8. Martin ST, Heneghan HM, Winter DC: Systematic review and meta-analysis of outcomes following pathological complete response to neoadjuvant chemoradiotherapy for rectal cancer. British Journal of Surgery 99:918-928, 2012

    9. Rastogi P, Anderson SJ, Bear HD, et al: Preoperative Chemotherapy: Updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27. Journal of Clinical Oncology 26:778-785, 2008

    10. Debled M, Mauriac L: Neoadjuvant chemotherapy: are we barking up the right tree? Annals of Oncology 21:675-679, 2010

  • Metrics
    No metrics available
Share - Bookmark