Prognostic value of persistent node involvement after neoadjuvant chemotherapy in patients with operable breast cancer

被引:94
作者
Pierga, JY
Mouret, E
Diéras, V
Laurence, V
Beuzeboc, P
Dorval, T
Palangié, T
Jouve, M
Vincent-Salomon, A
Scholl, S
Extra, JM
Asselain, B
Pouillart, P
机构
[1] Inst Curie, Dept Med Oncol, F-75248 Paris 05, France
[2] Inst Curie, Dept Biostat, F-75248 Paris 05, France
[3] Inst Curie, Dept Pathol, F-75248 Paris 05, France
关键词
neoadjuvant chemotherapy; breast cancer; pathological nodal metastasis;
D O I
10.1054/bjoc.2000.1461
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Neoadjuvant chemotherapy is able to reduce the size of the majority of breast tumours and down-stage axillary-node status. The aim of this study was to assess the prognostic value of persistent node involvement after neoadjuvant chemotherapy. A total of 488 patients with T2-T3, N0-N1 breast cancer treated by neoadjuvant chemotherapy followed by tumour excision and axillary lymph-node dissection between 1981 and 1992 were selected from the Institut Curie database. Median follow-up was 7 years. Overall objective response rate before local treatment was 52% and breast tumour size was reduced in 83% of patients. No pathologic nodal involvement was observed in 46.5% of patients. Patients with greater than or equal to eight positive nodes had a very poor median disease-free survival of only 20 months. Their IO-year disease-free survival rate was 7%, white the IO-year disease-free survival rate for patients with no node involvement was 64%. Median survival for patients with greater than or equal to eight nodes positive was 48 months and the 10-year survival rate was 26% (P < 0.0001). On multivariate analysis, outcome was strongly correlated with pathological nodal status, tumour grade, hormonal receptor status and clinical response of the tumour. in conclusion, patients with extensive nodal involvement after neoadjuvant chemotherapy have a very poor outcome. Second-line treatment should be considered in this population. (C) 2000 Cancer Research Campaign http://www.bjcancer.com.
引用
收藏
页码:1480 / 1487
页数:8
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