Identifying breast cancer patients at risk of relapse despite pathological complete response after neoadjuvant therapy
Jens Huober, Marion van Mackelenbergh, Andreas Schneeweiß, Fenja Seither, Jens‐Uwe Blohmer, Carsten Denkert, Hans Tesch, Claus Hanusch, Christoph Salat, Kerstin Rhiem, Christine Solbach, Peter A. Fasching, Christian Jackisch, Mattea Reinisch, Bianca Lederer, Keyur Mehta, Theresa Link, Valentina Nekljudova, Sibylle Loibl, Michael Untch
Abstract
This retrospective pooled analysis aims to identify factors predicting relapse despite a pathologic complete response (pCR) in patients with breast cancer (BC). 2066 patients with a pCR from five neoadjuvant GBG/AGO-B trials fulfill the inclusion criteria of this analysis. Primary endpoint is disease-free survival (DFS); secondary endpoints is distant DFS (DDFS) and overall survival (OS). After a median follow-up of 57.6 months, DFS is significantly worse for patients with positive lymph nodes (cN+ vs cN0 hazard ratio [HR] 1.94, 95%CI 1.48-2.54; p < 0.001). In patients with triple-negative tumors, lobular histology (lobular vs other HR 3.55, 95%CI 1.53-8.23; p = 0.003), and clinical nodal involvement (cN+ vs cN0 HR 2.45, 95%CI 1.59-3.79; p < 0.001) predict a higher risk of DFS events. Patients with HER2-positive cT3/4 tumors have a significantly higher risk of relapse (cT3/4 vs cT1 HR 2.07, 95%CI 1.06-4.03; p = 0.033). Initial tumor load and histological type predict relapse in patients with a pCR.