German Breast Group, Neu-Isenburg, Germany
Caterina Fontanella , Stephan Gade , Gunter Von Minckwitz , Bianca Lederer , Jens U. Blohmer , Serban Dan Costa , Carsten Denkert , Holger Eidtmann , Bernd Gerber , Claus A. Hanusch , Joern Hilfrich , Jens Bodo Huober , Andreas Schneeweiss , Stefan Paepke , Christian Jackisch , Keyur Mehta , Valentina Nekljudova , Michael Untch , Sibylle Loibl
Background: Luminal A breast cancer (BC) is considered a subtype with a good prognosis, but some poor prognostic factors can be identified, i.e. advanced stage and/or young age at presentation seem to be associated with higher risk of recurrence after neoadjuvant treatment (NAT). The importance of the progesterone receptor (PR) in Lum A BC prognosis has also been explored. Methods: We evaluated 2,248 patients with Lum A like BC (HER2-/estrogen receptor +/grade1-2) from 6 anthracycline-taxane based NAT trials (plus adjuvant endocrine therapy (ET) and radiotherapy if indicated). Combining tumor stage (AJCC Cancer Staging seventh), PR status, and age at baseline, we generated a score to divide Lum A like BC into 5 groups (Table). We used Kaplan Meier and uni/multivariate Cox regression analyses to explore the effect of the score on disease free (DFS) and overall survival (OS) and to evaluate its interaction with CPS+EG score (Mittendorf EA, JCO 2011), body mass index (BMI≤30/>30kg/m²), pCR (ypT0 ypN0), NAT density (conventional/dose-dense), and duration (24/18/≤12 weeks). Results: Mean DFS and OS decreased from score A to E (DFS: A 106.9 months, B 98.9, C 90.7, D 80.5, E 46.5; p< .001; OS: A 109.9 months, B 107.2, C 100.6, D 91.0, E 57.8; p< .001). Univar. analysis hazard ratios (HR) are displayed below. In multivar. analysis, our score independently predicted DFS (p< .001) and OS (p= .049). No interactions were observed (DFS: score*CPS+EG p= .440, s*BMI p= .347, s*pCR p= .462, s*density p= .350, s*duration p= .590; OS: s*CPS+EG= .734, s*BMI p= .784, s*pCR p= .999, s*density p= .870, s*duration p= .999). Conclusions: Using characteristics available in daily practice before treatment, we developed a score to identify Lum A like BC patients with poorer prognosis, despite NAT and ET, who are candidates for more aggressive NAT or additional postNAT in future studies.
SCORE (patients) | DFS |
OS |
|||||
---|---|---|---|---|---|---|---|
HR | 95%CI | p | HR | 95%CI | p | ||
A (686) | I-IIA/PR+/age≥40 | 1.0 | 1.0 | ||||
B (592) | IIB/PR+/age≥40 | 2.1 | 1.4-3.1 | < .001 | 1.8 | 1.1-3.0 | < .001 |
C (709) | I-IIA/PR-/age≥40 I-IIA/PR+/age<40 IIB/PR+/age<40 IIIA-B/PR+/age≥40 |
3.4 | 2.4-4.9 | < .001 | 3.0 | 1.8-4.8 | < .001 |
D (230) | I-IIA/PR-/age<40 IIB/PR-/any age IIIA-B/PR+/age<40 IIIA-B/PR-/any age |
5.4 | 3.6-8.1 | < .001 | 4.8 | 2.8-8.4 | < .001 |
E (31) | IIIC | 11.7 | 6.3-21.6 | < .001 | 10.9 | 4.8-24.6 | < .001 |
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