CLINICAL PROGNOSTIC AND PREDICTIVE FACTORS FOR PRIMARY CHEMOTHERAPY IN OPERABLE BREAST-CANCER

Purpose: This study aimed to identify clinical factors that are of pro gnostic significance or that predict for subsequent treatment outcome in patients with large operable breast cancer treated with primary che motherapy (PCT) at our institution. Methods: One hundred eighty-five p atients received the following regimens: CMF or MMM (76 patients), ECF (75 patients), AC or FEC (34 patients), followed by surgery, with rad iotherapy (RT) given to those with breast conservation. A number of co mmon clinical variables were assessed in relation to local recurrence- free survival (LRFS), disease-free survival (DFS), and overall surviva l (OS). Results: Clinical responders had improved DFS (P = .009) and O S (P = .08) compared with nonresponders. There was no association betw een clinical or pathologic complete remission (CR) and survival. Pretr eatment clinical axillary node positivity was a significant predictor of worsened DFS (P = .0001), OS (P = .0001), and LRFS (P = .03). Patie nts remaining clinically node-positive postchemotherapy had an inferio r outcome compared with those becoming node-negative (DFS, P = .03; OS , P = .03) but pathologic axillary node status was not shown to predic t for survival. Twenty-nine patients in clinical CR following PCT who electively did not have surgery and were treated with RT alone had sig nificantly increased local recurrence rate compared with partial respo nders having surgery and RT (P = .02). There were no differences in DF S or OS between these groups. On multivariate analysis, clinical axill ary node status was the only independent predictor of OS and DFS, and LRFS. Conclusion: Pretreatment and posttreatment clinical axillary nod e status is a major predictor of outcome following PCT. Complete clini cal response does not define a more favorable subgroup compared with t hose not obtaining CR. (C) 1998 by American Society of Clinical Oncolo gy.