Japanese Journal of Clinical Oncology Advance Access originally published online on May 28, 2009
Japanese Journal of Clinical Oncology 2009 39(8):484-490; doi:10.1093/jjco/hyp052
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© The Author (2009). Published by Oxford University Press. All rights reserved
Long-term Outcome and Pattern of Relapse after Neoadjuvant Chemotherapy in Patients with Human Epidermal Growth Factor Receptor 2-positive Primary Breast Cancer
1 Division of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo
2 Department of Surgery, Osaka National Hospital, Osaka
3 Division of Clinical Trial Design and Management, Translational Research Center, Kyoto University Hospital, Kyoto
4 Department of Pathology, National Cancer Center Hospital
5 Department of Central Laboratory and Surgical Pathology, Osaka National Hospital, Osaka, Japan
For reprints and all correspondence: Chikako Shimizu, Division of Breast and Medical Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan. E-mail: cshimizu{at}ncc.go.jp
Received February 6, 2009; accepted April 30, 2009
Objective: Determinants of long-term outcome of patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer who received neoadjuvant chemotherapy (NAC) are not clear. The purpose of this study was to explore the prognostic factors of HER2-positive breast cancer patients administered NAC.
Methods: A retrospective analysis of 125 HER2-positive breast cancer patients treated by NAC using an anthracycline plus taxane with (HCN group, n = 54) or without trastuzumab (non-HCN group, n = 71) was performed. The clinical parameters, including the pathological complete remission (pCR) rate, disease-free survival (DFS) and organ-specific recurrence-free survival, were measured.
Results: According to the results of the univariate analyses, age, clinical stage, pCR and axillary lymph node status were the factors significantly associated with the DFS. The inclusion of trastuzumab in the NAC regimen did not yield a significant difference in the DFS. Only the axillary lymph node status and age were found to be the significant factors affecting the DFS in a multivariate model. There were no significant differences in the patient/tumor characteristics between the HCN and non-HCN groups except for the pCR rate (50% in the HCN group vs. 24% in the non-HCN group) and the median follow-up time (738 days in the HCN group vs. 1579 days in the non-HCN group). Within the first 2 years from the initiation of NAC treatment, the central nervous system (CNS) was the most common site of first recurrence in the HCN group, whereas no cases of CNS metastasis were observed in the non-HCN group.
Conclusions: The pathological axillary node status and age were found to be the significant prognostic factors in HER2-positive breast cancer patients who received NAC. The pattern of recurrence may be different between HCN-treated and non-HCN-treated patients.
Key Words: breast cancer • human epidermal growth factor receptor 2 (her2) • neoadjuvant chemotherapy • pathological response • prognosis