Originally published as JCO Early Release 10.1200/JCO.2007.11.5352 on December 3 2007

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Combined Use of Clinical and Pathologic Staging Variables to Define Outcomes for Breast Cancer Patients Treated With Neoadjuvant Therapy

Jacqueline S. Jeruss, Elizabeth A. Mittendorf, Susan L. Tucker, Ana M. Gonzalez-Angulo, Thomas A. Buchholz, Aysegul A. Sahin, Janice N. Cormier, Aman U. Buzdar, Gabriel N. Hortobagyi, Kelly K. Hunt

From the Departments of Surgical Oncology, Bioinformatics and Computational Biology, Breast Medical Oncology, Radiation Oncology, and Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX; Department of Surgery, Northwestern University Feinberg School of Medicine; and Robert H. Lurie Comprehensive Cancer Center, Chicago, IL

Corresponding author: Kelly K. Hunt, MD, Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 444, Houston, TX 77030; e-mail: khunt{at}mdanderson.org

Purpose Neoadjuvant chemotherapy is being used with increasing frequency for operable breast cancer. We hypothesized that by using clinical and pathologic staging parameters, in conjunction with biologic tumor markers, a novel means of determining prognosis for patients treated with neoadjuvant chemotherapy could be facilitated.

Patients and Methods A prospective database of patients treated with neoadjuvant chemotherapy from 1997 to 2003 was reviewed, and 932 patients meeting inclusion criteria were identified. Clinical and pathologic tumor characteristics, treatment regimens, and patient outcomes were recorded. Cox proportional hazards models were used to create two prognostic scoring systems. American Joint Committee on Cancer (AJCC) clinical and pathologic staging parameters and biologic tumor markers were investigated to devise the scoring systems.

Results Median follow-up time was 5 years (range, 0.4 to 9.4 years). Five-year disease-specific survival rate was 96% for patients who experienced a pathologic complete response (pCR; n = 130) compared with 87% for patients who did not have a pCR (n = 802; P = .001). Two scoring systems, based on summing binary indicators for clinical substages IIB and IIIB, pathologic substages ypIIA and ypIIIC, negative estrogen receptor status, and grade 3 pathology, were devised to predict 5-year patient outcomes. These scoring systems facilitated separation of the study population into more refined subgroups by outcome than the current AJCC staging system.

Conclusion The scoring systems derived in this work provide a novel means for evaluating prognosis after neoadjuvant therapy. Future work will focus on prospective validation of these scoring systems and refinement of the scoring systems through addition of new biologic markers.

published online ahead of print at www.jco.org on December 3, 2007.

Presented in part at the 29th Annual San Antonio Breast Cancer Symposium, December 14-17, 2006, San Antonio, TX.

J.S.J. was named an AstraZeneca Scholar when this work was presented at the 29th Annual San Antonio Breast Cancer Symposium.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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