Neoadjuvant chemotherapy in young breast cancer patients: Correlation between response and relapse?

The aim, of this analysis was to assess how the clinical response to chemot herapy corresponded to long-term prognosis in patients of less than 35 year s of age. A retrospective analysis was made of response and survival data o f 609 premenopausal patients who had been treated by four cycles of neoadju vant chemotherapy followed by surgery and/or radiotherapy. Patients were st ratified into three age groups (group 1, less than or equal to 35 years; gr oup 2, 35-40 years; group 3, greater than or equal to 41 years). Objective and complete clinical response rates were significantly higher in the young est patients (below 35 yrs: P = 0.005 and P=0.001, respectively) in stark c ontrast to a particularly poor outcome of this subpopulation. Five-year loc al recurrence rates were 31% in the youngest patients, compared with 26% an d 16% in groups 2 and 3, respectively (P = 0.0007). Group 1 patients also h ad significantly higher 5-year metastatic relapse rates (41% versus 35% and 28%; P = 0.007) and 5-year survival figures were 70%, 82% and 84% for grou ps 1, 2 and 3 respectively (P=0.002). Finally, stratification by age and by response revealed that, whilst the outcome of the youngest patients was hi ghly dependent on their response to primary chemotherapy, complete responde rs showed disease-free survival rates at 5 years that were lower than these of older patients, whatever their response. Despite a seemingly better con trol of the primary tumour by chemotherapy, the patients in the youngest ag e group remained at a high risk for local and metastatic relapse. This appa rent paradox may be in part attributable to rapid disease progression of mi crometastatic tumour subpopulations that are refractory to chemotherapy. (C ) 1999 Elsevier Science Ltd. All rights reserved.