Long-term outcome of neoadjuvant systemic therapy for locally advanced breast cancer in routine clinical practice
Menée sur 409 patientes atteintes d'un cancer du sein localement avancé, cette étude évalue, du point de vue de la survie sans récidive ou de la survie globale et en fonction du type tumoral, les résultats à long terme d'un traitement systémique néoadjuvant standard suivi d'une intervention chirurgicale combinée à un traitement adjuvant et à une radiothérapie (durée médiane de suivi : 42 mois)
Purpose The aim of this study is to evaluate the long-term outcome of patients with locally advanced breast cancer treated with neoadjuvant systemic chemotherapy (NST) in routine clinical practice. Methods Four hundred and nine patients were identified between January 1999 and December 2011. All patients received NST followed by surgery, adjuvant treatments and radiotherapy, as appropriate. Results At Kaplan–Meier analysis, patients with surgical stage III disease were more likely to develop distant metastasis and die from breast cancer ( p < 0.001). Luminal A and luminal B/HER2-negative patients had better prognosis; moreover, patients with hormone receptor (HR)-positive tumors had a significantly longer DRFS ( p < 0.0049) and OS ( p < 0.0001) compared with patients with HR-negative tumors as well as patients who underwent breast-conserving surgery (DRFS and OS: p < 0.001). In multivariate analysis, HR negativity ( p < 0.001 for both DRFS and OS), mastectomy (DRFS: p = 0.009; OS: p = 0.05) and stage III disease (DRFS: p < 0.001; OS: p = 0.003) were associated with shorter DRFS and OS. Conclusions HR negativity, mastectomy and pathological stage III disease are the variables independently associated with a worse outcome in our cohort of patients. These data are of high interest since they derive from a very heterogeneous group of patients, treated with different neoadjuvant/adjuvant regimens outside of clinical trials and with a long follow-up period.