Journal article
Patterns of Distant Failure by Intrinsic Breast Cancer Subtype in Premenopausal Women Treated With Neoadjuvant Chemotherapy
Clinical breast cancer, Vol.18(5), pp.e1077-e1085
10/2018
DOI: 10.1016/j.clbc.2018.04.020
PMID: 29843987
Abstract
Young women with breast cancer have worse outcomes compared to their older counterparts, yet this patient population is infrequently studied on its own. We sought to identify patterns of failure by breast cancer subtype in premenopausal women receiving neoadjuvant chemotherapy. Distant failure was more common than locoregional failure, and patterns of failure differed by breast cancer subtype. Time from the development of metastatic disease to death and overall survival also differed by breast cancer subtype.
To identify patterns of distant failure (DF) in premenopausal women receiving neoadjuvant chemotherapy (NAC) for breast cancer.
Premenopausal patients treated with NAC between 2005 and 2015 at a single institution were retrospectively reviewed. Timing and location of local, regional, and distant metastases were described. Predictors for DF and overall survival (OS) were analyzed.
Of 225 patients, there were 24 (10.7%) local, 30 (13.3%) regional, and 63 (28.0%) distant recurrences. Cumulative incidence of DF was higher in patients younger than age 40 (P = .01), in those with residual tumor size > 2 cm (P < .0001), in those with positive lymph nodes after NAC (P = .0003), and in those without pathologic complete response (P < .0001). Cumulative incidence of brain metastases was most common in patients with human epidermal growth factor receptor 2 (HER2)-positive disease (P = .05). Time from development of metastatic disease to death varied by breast cancer subtype (P = .019), as did 5-year OS (P = .024). Women with HER2-positive and triple-negative disease had the highest incidence of brain metastases and the shortest time from development of metastases to death. On multivariable analysis, luminal B subtype (P = .025), pathologic complete response (P = .0014), young age (P = .0008), lack of hormone therapy (P < .0001), lymphovascular space involvement (P < .0001), and pathologic size of the primary tumor (P < .0001) were all significant predictors for DF.
Patterns of DF after NAC in premenopausal women vary by breast cancer subtype, with DF more common than locoregional failure. Young age remains an independent poor prognostic factor, and OS differs by breast cancer subtype.
Details
- Title: Subtitle
- Patterns of Distant Failure by Intrinsic Breast Cancer Subtype in Premenopausal Women Treated With Neoadjuvant Chemotherapy
- Creators
- Margaret M. Kozak - Department of Radiation Oncology, Stanford Cancer Institute, Stanford CA.Clare E. Jacobson - Department of Radiation Oncology, Stanford Cancer Institute, Stanford CA.Rie von Eyben - Department of Radiation Oncology, Stanford Cancer Institute, Stanford CA.Emily Walck - Stanford UniversityErqi L. Pollom - Department of Radiation Oncology, Stanford Cancer Institute, Stanford CA.Melinda Telli - Department of Medicine, Division of Medical Oncology, Stanford Cancer Institute, Stanford, CAKathleen C. Horst - Department of Radiation Oncology, Stanford Cancer Institute, Stanford CA.
- Resource Type
- Journal article
- Publication Details
- Clinical breast cancer, Vol.18(5), pp.e1077-e1085
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.clbc.2018.04.020
- PMID
- 29843987
- ISSN
- 1526-8209
- eISSN
- 1938-0666
- Language
- English
- Date published
- 10/2018
- Academic Unit
- Radiation Oncology
- Record Identifier
- 9984313075102771
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