Predicting the Response of Neoadjuvant Chemotherapy in Hormone Receptor-Positive, Human Epidermal Growth Factor Receptor 2-Negative Breast Cancer With Axillary Lymph Node Metastasis by Multigene Assay

Clinicopathological characteristics and survival analysis of different molecular subtypes of breast invasive ductal carcinoma achieving pathological complete response through neoadjuvant chemotherapy

BACKGROUND

To investigate the prognostic differences following the achievement of a pathological complete response (pCR) through neoadjuvant chemotherapy across different molecular subtypes of breast invasive ductal carcinoma.

METHODS

Data from the Surveillance, Epidemiology, and End Results (SEER) were identified for patients undergoing neoadjuvant chemotherapy who achieved pathological complete response for invasive ductal carcinoma of the breast between 2010 and 2019.Comparing the clinicopathological characteristics of patients across different molecular subtypes. Univariate and Cox multivariate analyses were utilized to identify independent predictors of overall survival (OS) and cancer-specific survival (CSS). The Kaplan-Meier method is used to compare OS and CSS among different molecular subtypes. After propensity score matching, subgroup analysis results were presented through forest plots.

RESULTS

This study included 9,380 patients diagnosed with invasive ductal carcinoma, who were categorized into four molecular subtypes: 2,721 (29.01%) HR + /HER-2 + , 1,661 (17.71%) HR + /HER2-, 2,082 (22.20%) HR-/HER2 + , and 2,916 (31.08%) HR-/HER-2-. HR + /HER-2- subgroup exhibited a significantly higher proportion of patients under 50 years old than the other subtype groups (54.67% vs 40.2%, 50.35% and 51.82%, p < 0.01), and had a higher N2 + N3 stage (11.2% vs 7.24%, 8.69% and 7.48%, p < 0.01). Univariate and multivariate analysis revealed that molecular subtype was the independent risk factor for OS and CSS in patients(p < 0.05). The Kaplan-Meier curves indicated that the HR + /HER-2 + subtype had the highest OS and CSS(p < 0.05). Next, were the HR-/HER-2 + and HR-/HER-2- subtypes, with the HR + /HER-2- group having the lowest OS and CSS(p < 0.05). After propensity score matching, the OS and CSS of patients in the HR + /HER-2 + group remained higher compared to HR + /HER-2- group(p < 0.05).

CONCLUSIONS

Patients with invasive ductal carcinoma of different molecular subtypes exhibit varying prognoses after achieving pCR to neoadjuvant chemotherapy. Those in the HR + /HER-2- group are younger, have a higher lymph node stage, and the lowest OS and CSS, whereas patients in the HR + /HER-2 + group have the highest OS and CSS.

Evaluation of treatment responses among subgroups of breast cancer patients receiving neoadjuvant chemotherapy

BACKGROUND

Breast MRIs are helpful for determining treatment plans, responses, and prospective survival analyses. In this retrospective cross-sectional study, we compared the preoperative MRI treatment response to neoadjuvant chemotherapy (NAC) administration with the postoperative pathological response in breast cancer patients.

MATERIALS AND METHODS

We analyzed data from 108 hospitalized patients receiving NAC between 2020 and 2022. We used MRI to evaluate the treatment response to NAC in patients with locally advanced breast cancers who had not received any prior treatment. We recorded the longest diameter of the primary tumor and the numbers of secondary tumors and axillary lymph nodes. In addition, we examined the correlation between the MRI response rate and pathological specimen results.

RESULTS

In our subgroup analyses, we found the best pathological response in patients with luminal B (Ki-67 index >14%) breast cancer and positivity for both hormone receptor and HER-2 markers. After comparing the pathological and radiological treatment responses in tumors and lymph nodes, the sensitivities were 90.3% for the pathological assessment and 42.8% for the radiological assessment, while the accuracies were 84.2% for the pathological assessment and 61.1% for the radiological assessment.

CONCLUSION

Using MRI techniques and sequence intervals and examining the histopathological characteristics of tumors may help increase the accuracy of the pathological complete response.