Factors predictive of outcome in patients with breast cancer refractory toneoadjuvant chemotherapy

PURPOSE The purpose of this study was to determine the clinical, pathological, and treatment factors that are predictive of local-regional recurrence and over all survival for patients with breast cancer that is refractory to neoadjuv ant chemotherapy. PATIENTS AND METHODS This study analyzed the data of the 177 breast cancer patients treated on o ur institutional protocols who had less than a partial response to neoadjuv ant chemotherapy. The initial clinical stage of disease was II In 27%, III in 69%, and IV (supraclavicular lymph node involvement) in 4%. Surgery was performed in 94% of the patients, and 77% of these patients also received a djuvant chemotherapy. RESULTS After a median follow-up of 5.2 years, 106 patients experienced disease rec urrence, with 98 of these having distant metastases and 45 having local-reg ional recurrence. The 5- and 10-year overall survivals for the entire group were 56% and 33%, respectively. The factors that were independently associ ated with a statistically significant poorer overall survival in a Cox regr ession analysis were pathologically involved lymph nodes after surgery, est rogen receptor-negative disease, and progressive diseaseduring neoadjuvant chemotherapy. The 5-year overall survival for patients with pathologically negative lymph nodes ranged from 84% (estrogen receptor-positive disease) to 75% (estroge n receptor-negative disease), compared with rates for patients with patholo gically positive lymph nodes of 66% (estrogen receptor-positive disease) an d 40% (estrogen receptor-negative disease). The 5-year survival of patients with progressive disease was only 19%. The 5- and 10-year local-regional r ecurrence rates for the 177 patients were 27% and 34%, respectively. Signif icant factors on Cox analysis that predicted for local-regional recurrence were four or more pathologically involved lymph nodes and estrogen receptor -negative disease. For the 105 patients treated with surgery and postoperat ive radiation therapy, the 10-year local-regional recurrence rates for the subgroups with 0, 1, or 2 of these factors were 12%, 25%, and 44%, respecti vely. CONCLUSIONS For patients with a poor response to neoadjuvant chemotherapy, conventional treatments achieve reasonable outcomes in those with lymph node-negative d isease or estrogen receptor-positive disease. However, more active systemic and local therapies are needed for patients with estrogen receptor-negativ e disease and positive lymph nodes and for those with clinical evidence of progressive disease during neoadjuvant chemotherapy.