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Pathological non-response to chemotherapy in a neoadjuvant setting of breast cancer: an inter-institutional study

Balmativola, D.; Marchio, C.; Maule, M.; Chiusa, L.; Annaratone, L.; Maletta, F.; Montemurro, F.; Kulka, J.; Figueiredo, P. and Varga, Z., et al. (2014) In Breast Cancer Research and Treatment 148(3). p.511-523
Abstract
To identify markers of non-response to neoadjuvant chemotherapy (NAC) that could be used in the adjuvant setting. Sixteen pathologists of the European Working Group for Breast Screening Pathology reviewed the core biopsies of breast cancers treated with NAC and recorded the clinico-pathological findings (histological type and grade; estrogen, progesterone receptors, and HER2 status; Ki67; mitotic count; tumor-infiltrating lymphocytes; necrosis) and data regarding the pathological response in corresponding surgical resection specimens. Analyses were carried out in a cohort of 490 cases by comparing the groups of patients showing pathological complete response (pCR) and partial response (pPR) with the group of non-responders (pathological... (More)
To identify markers of non-response to neoadjuvant chemotherapy (NAC) that could be used in the adjuvant setting. Sixteen pathologists of the European Working Group for Breast Screening Pathology reviewed the core biopsies of breast cancers treated with NAC and recorded the clinico-pathological findings (histological type and grade; estrogen, progesterone receptors, and HER2 status; Ki67; mitotic count; tumor-infiltrating lymphocytes; necrosis) and data regarding the pathological response in corresponding surgical resection specimens. Analyses were carried out in a cohort of 490 cases by comparing the groups of patients showing pathological complete response (pCR) and partial response (pPR) with the group of non-responders (pathological non-response: pNR). Among other parameters, the lobular histotype and the absence of inflammation were significantly more common in pNR (p < 0.001). By ROC curve analyses, cut-off values of 9 mitosis/2 mm(2) and 18 % of Ki67-positive cells best discriminated the pNR and pCR + pPR categories (p = 0.018 and < 0.001, respectively). By multivariable analysis, only the cut-off value of 9 mitosis discriminated the different response categories (p = 0.036) in the entire cohort. In the Luminal B/HER2- subgroup, a mitotic count < 9, although not statistically significant, showed an OR of 2.7 of pNR. A lobular histotype and the absence of inflammation were independent predictors of pNR (p = 0.024 and < 0.001, respectively). Classical morphological parameters, such as lobular histotype and inflammation, confirmed their predictive value in response to NAC, particularly in the Luminal B/HER2- subgroup, which is a challenging breast cancer subtype from a therapeutic point of view. Mitotic count could represent an additional marker but has a poor positive predictive value. (Less)
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keywords
Breast cancer, Neoadjuvant therapy, Non-response, Mitotic count, Proliferation
in
Breast Cancer Research and Treatment
volume
148
issue
3
pages
511 - 523
publisher
Springer
external identifiers
  • wos:000345370600005
  • scopus:84911901979
ISSN
1573-7217
DOI
10.1007/s10549-014-3192-3
language
English
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yes
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a39b70e7-a3f5-4edc-85af-9bd51fa54fb5 (old id 4965883)
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2015-02-03 07:08:01
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@article{a39b70e7-a3f5-4edc-85af-9bd51fa54fb5,
  abstract     = {To identify markers of non-response to neoadjuvant chemotherapy (NAC) that could be used in the adjuvant setting. Sixteen pathologists of the European Working Group for Breast Screening Pathology reviewed the core biopsies of breast cancers treated with NAC and recorded the clinico-pathological findings (histological type and grade; estrogen, progesterone receptors, and HER2 status; Ki67; mitotic count; tumor-infiltrating lymphocytes; necrosis) and data regarding the pathological response in corresponding surgical resection specimens. Analyses were carried out in a cohort of 490 cases by comparing the groups of patients showing pathological complete response (pCR) and partial response (pPR) with the group of non-responders (pathological non-response: pNR). Among other parameters, the lobular histotype and the absence of inflammation were significantly more common in pNR (p &lt; 0.001). By ROC curve analyses, cut-off values of 9 mitosis/2 mm(2) and 18 % of Ki67-positive cells best discriminated the pNR and pCR + pPR categories (p = 0.018 and &lt; 0.001, respectively). By multivariable analysis, only the cut-off value of 9 mitosis discriminated the different response categories (p = 0.036) in the entire cohort. In the Luminal B/HER2- subgroup, a mitotic count &lt; 9, although not statistically significant, showed an OR of 2.7 of pNR. A lobular histotype and the absence of inflammation were independent predictors of pNR (p = 0.024 and &lt; 0.001, respectively). Classical morphological parameters, such as lobular histotype and inflammation, confirmed their predictive value in response to NAC, particularly in the Luminal B/HER2- subgroup, which is a challenging breast cancer subtype from a therapeutic point of view. Mitotic count could represent an additional marker but has a poor positive predictive value.},
  author       = {Balmativola, D. and Marchio, C. and Maule, M. and Chiusa, L. and Annaratone, L. and Maletta, F. and Montemurro, F. and Kulka, J. and Figueiredo, P. and Varga, Z. and Liepniece-Karele, I. and Cserni, G. and Arkoumani, E. and Amendoeira, I. and Callagy, G. and Reiner-Concin, A. and Cordoba, A. and Bianchi, S. and Decker, T. and Glaeser, D. and Focke, C. and van Diest, P. and Grabau, Dorthe and Lips, E. and Wesseling, J. and Arisio, R. and Medico, E. and Wells, C. and Sapino, A.},
  issn         = {1573-7217},
  keyword      = {Breast cancer,Neoadjuvant therapy,Non-response,Mitotic count,Proliferation},
  language     = {eng},
  number       = {3},
  pages        = {511--523},
  publisher    = {Springer},
  series       = {Breast Cancer Research and Treatment},
  title        = {Pathological non-response to chemotherapy in a neoadjuvant setting of breast cancer: an inter-institutional study},
  url          = {http://dx.doi.org/10.1007/s10549-014-3192-3},
  volume       = {148},
  year         = {2014},
}