Survival Outcomes of Patients with Locally Advanced Breast Cancer after Neoadjuvant Systemic Therapy in St. Luke’s Medical Center

Abstract

Background: In locally-advanced breast cancers (LABC), the previous primary goal of neoadjuvant systemic therapy was to improve resectability and achieve better margins. Currently, it can also provide important prognostic information based on actual response to therapy. Achieving pathologic complete response (pCR) after neoadjuvant therapy is targeted because it is associated with favorable disease-free survival (DFS) and overall survival (OS). The purpose of this study is to report the 5-year disease-free survival rate and overall survival rate among patients with LABC treated with neoadjuvant treatment followed by surgery. Methods: All patients with histologically diagnosed locally advanced breast cancer, who completed neoadjuvant therapy and surgery at St. Luke’s Medical Center from January 2007 to December 2017 where included. Response to neoadjuvant therapy were categorized using post-surgical pathologic reports. Survival curves were generated by the Kaplan-Meier method and compared using the log-rank test. Results: The cohort included 231 women, most were diagnosed with stage III disease (n=151). Pathologic complete response to neoadjuvant treatment had a significantly greater 5-year disease-free survival at 73.17% compared to those with residual disease after neoadjuvant treatment at 51.25% (Log-rank test p=0.0107). The locoregional recurrence-free survival and distant metastasis-free survival were 83.20% and 62.0% at 5 years, respectively. No deaths were recorded at 5 years for patients who achieved pathologic complete response after neoadjuvant chemotherapy. Conclusion: Pathologic complete response has better outcomes in terms of disease-free survival compared to those who did not achieve complete pathologic response after neoadjuvant therapy. Disease-free survival among patients who achieved pathologic complete response does not significantly differ among the different molecular phenotypes. The overall survival of the patients in this cohort does not differ in terms of phenotypic subtypes and mortality is seen among patients with disease progression.

Keywords

• neoadjuvant
• breast cancer
• survival outcomes after neoadjuvant