Influence of endocrine-related factors on response to perioperative chemotherapy for patients with node-negative breast cancer

Purpose: We investigated tumor- and patient-related features that might inf luence the response to perioperative chemotherapy (PeCT) compared with no a djuvant therapy for patients with node-negative breast cancer. Patients and Methods: A total of 1,275 patients were randomized to either n o adjuvant treatment (427 patients) or PeCT (848 patients). The following v ariables thought to have prognostic significance were evaluated: grade, tum or size, estrogen (ER) and progesterone receptor (PgR) content (absent; low , 1 to 9 fmol/mg cytosol protein; or positive, greater than or equal to 10 fmol/mg cytosol protein), c-erbB-2 overexpression, menopausal status, and a ge. Cox proportional hazards regression models were used to assess the rela tive influence of these factors to predict the effect of PeCT on disease-fr ee survival (DFS). Median follow-up was 13.5 years. Results: The 10-year DFS percentage for 692 premenopausal patients did not significantly differ be-tween the PeCT and no-adjuvant-treatment groups: 61 % and 59%, respectively (relative risk [RR], 0.95; 95% confidence interval [Cl], 0.75 to 1.20; P = .70). No predictive factors were identified. For 58 3 postmenopausal patients, 10-year DFS percentages for the groups were 63% and 58%, respectively (RR, 0.75; 95% Cl, 0.58 to 0.93; P = .03). The absenc e of expression of ER, PgR, or both ER and PgR was the most important facto r predicting improved outcome with PeCT among postmenopausal patients. The 10-year DFS percentages were 85% and 53% for the steroid hormone receptor-a bsent cohort of treated and untreated patients, respectively (RR, 0.18; 95% Cl, 0.06 to 0.49; P = .0009). Conclusion: The role of PeCT should be explored for patients whose primary tumors do not express steroid hormone receptors, because it is likely that early initiation of treatment is exclusively relevant for such patients. J Clin Oncol 79.4747-4149. (C) 2001 by American Society of Clinical Oncology.