Breast conservation after neoadjuvant chemotherapy: A prognostic index for clinical decision-making

Allen M. Chen, Funda Meric-Bernstam, Kelly K. Hunt, Howard D. Thames, Elesyia D. Outlaw, Eric A. Strom, Marsha D. McNeese, Henry M. Kuerer, Merrick I. Ross, Eva E. Singletary, Fredrick C. Ames, Barry W. Feig, Aysegul A. Sahin, George H. Perkins, Gildy Babiera, Gabriel N. Hortobagyi, Thomas A. Buchholz

Research output: Contribution to journalArticle

112 Citations (Scopus)

Abstract

BACKGROUND. The appropriate selection criteria for breast-conserving therapy (BCT) after neoadjuvant chemotherapy are poorly defined. The purpose of the current report was to develop a prognostic index to help refine selection criteria and to serve as a general framework for clinical decision-making for patients treated by this multimodality approach. METHODS. From a group of 340 patients treated with BCT after neoadjuvant chemotherapy, the authors previously determined 4 statistically significant predictors of ipsilateral breast tumor recurrence (IBTR) and locoregional recurrence (LRR): clinical N2 or N3 disease, residual pathologic tumor size > than 2 cm, a multifocal pattern of residual disease, and lymphovascular space invasion in the specimen. The M. D. Anderson Prognostic Index (MDAPI) was developed by assigning scores of 0 (favorable) or 1 (unfavorable) for each of these 4 variables and using the total to give an overall MDAPI score of 0-4. RESULTS. The MDAPI stratified the 340 patients into 3 subsets with statistically different levels of risk for IBTR and LRR after neoadjuvant chemotherapy and BCT. Actuarial 5-year IBTR-free survival rates were 97%, 88%, and 82% for patients in the low (MDAPI overall score 0 or 1, n = 276), intermediate (MDAPI score 2, n = 43), and high (MDAPI score 3 or 4, n = 12) risk groups, respectively (P < 0.001). Corresponding actuarial 5-year LRR-free survival rates were 94%, 83%, and 58%, respectively (P < 0.001). CONCLUSIONS. Patients with an MDAPI score of 0 or 1, which made up 81% of the study population, had very low rates of IBTR and LRR. The MDAPI enabled the identification of a small group (4%) of patients who are at high risk for IBTR and LRR and who may benefit from alternative locoregional treatment strategies.

Original languageEnglish (US)
Pages (from-to)689-695
Number of pages7
JournalCancer
Volume103
Issue number4
DOIs
StatePublished - Feb 15 2005
Externally publishedYes

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Breast
Recurrence
Drug Therapy
Breast Neoplasms
Neoadjuvant Therapy
Patient Selection
Survival Rate
Clinical Decision-Making
Residual Neoplasm
Therapeutics
Population

Keywords

  • Breast conservation
  • Ipsilateral breast tumor
  • Neoadjuvant chemotherapy
  • Prognostic index

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Chen, A. M., Meric-Bernstam, F., Hunt, K. K., Thames, H. D., Outlaw, E. D., Strom, E. A., ... Buchholz, T. A. (2005). Breast conservation after neoadjuvant chemotherapy: A prognostic index for clinical decision-making. Cancer, 103(4), 689-695. https://doi.org/10.1002/cncr.20815

Breast conservation after neoadjuvant chemotherapy : A prognostic index for clinical decision-making. / Chen, Allen M.; Meric-Bernstam, Funda; Hunt, Kelly K.; Thames, Howard D.; Outlaw, Elesyia D.; Strom, Eric A.; McNeese, Marsha D.; Kuerer, Henry M.; Ross, Merrick I.; Singletary, Eva E.; Ames, Fredrick C.; Feig, Barry W.; Sahin, Aysegul A.; Perkins, George H.; Babiera, Gildy; Hortobagyi, Gabriel N.; Buchholz, Thomas A.

In: Cancer, Vol. 103, No. 4, 15.02.2005, p. 689-695.

Research output: Contribution to journalArticle

Chen, AM, Meric-Bernstam, F, Hunt, KK, Thames, HD, Outlaw, ED, Strom, EA, McNeese, MD, Kuerer, HM, Ross, MI, Singletary, EE, Ames, FC, Feig, BW, Sahin, AA, Perkins, GH, Babiera, G, Hortobagyi, GN & Buchholz, TA 2005, 'Breast conservation after neoadjuvant chemotherapy: A prognostic index for clinical decision-making', Cancer, vol. 103, no. 4, pp. 689-695. https://doi.org/10.1002/cncr.20815
Chen AM, Meric-Bernstam F, Hunt KK, Thames HD, Outlaw ED, Strom EA et al. Breast conservation after neoadjuvant chemotherapy: A prognostic index for clinical decision-making. Cancer. 2005 Feb 15;103(4):689-695. https://doi.org/10.1002/cncr.20815
Chen, Allen M. ; Meric-Bernstam, Funda ; Hunt, Kelly K. ; Thames, Howard D. ; Outlaw, Elesyia D. ; Strom, Eric A. ; McNeese, Marsha D. ; Kuerer, Henry M. ; Ross, Merrick I. ; Singletary, Eva E. ; Ames, Fredrick C. ; Feig, Barry W. ; Sahin, Aysegul A. ; Perkins, George H. ; Babiera, Gildy ; Hortobagyi, Gabriel N. ; Buchholz, Thomas A. / Breast conservation after neoadjuvant chemotherapy : A prognostic index for clinical decision-making. In: Cancer. 2005 ; Vol. 103, No. 4. pp. 689-695.
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abstract = "BACKGROUND. The appropriate selection criteria for breast-conserving therapy (BCT) after neoadjuvant chemotherapy are poorly defined. The purpose of the current report was to develop a prognostic index to help refine selection criteria and to serve as a general framework for clinical decision-making for patients treated by this multimodality approach. METHODS. From a group of 340 patients treated with BCT after neoadjuvant chemotherapy, the authors previously determined 4 statistically significant predictors of ipsilateral breast tumor recurrence (IBTR) and locoregional recurrence (LRR): clinical N2 or N3 disease, residual pathologic tumor size > than 2 cm, a multifocal pattern of residual disease, and lymphovascular space invasion in the specimen. The M. D. Anderson Prognostic Index (MDAPI) was developed by assigning scores of 0 (favorable) or 1 (unfavorable) for each of these 4 variables and using the total to give an overall MDAPI score of 0-4. RESULTS. The MDAPI stratified the 340 patients into 3 subsets with statistically different levels of risk for IBTR and LRR after neoadjuvant chemotherapy and BCT. Actuarial 5-year IBTR-free survival rates were 97{\%}, 88{\%}, and 82{\%} for patients in the low (MDAPI overall score 0 or 1, n = 276), intermediate (MDAPI score 2, n = 43), and high (MDAPI score 3 or 4, n = 12) risk groups, respectively (P < 0.001). Corresponding actuarial 5-year LRR-free survival rates were 94{\%}, 83{\%}, and 58{\%}, respectively (P < 0.001). CONCLUSIONS. Patients with an MDAPI score of 0 or 1, which made up 81{\%} of the study population, had very low rates of IBTR and LRR. The MDAPI enabled the identification of a small group (4{\%}) of patients who are at high risk for IBTR and LRR and who may benefit from alternative locoregional treatment strategies.",
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T1 - Breast conservation after neoadjuvant chemotherapy

T2 - A prognostic index for clinical decision-making

AU - Chen, Allen M.

AU - Meric-Bernstam, Funda

AU - Hunt, Kelly K.

AU - Thames, Howard D.

AU - Outlaw, Elesyia D.

AU - Strom, Eric A.

AU - McNeese, Marsha D.

AU - Kuerer, Henry M.

AU - Ross, Merrick I.

AU - Singletary, Eva E.

AU - Ames, Fredrick C.

AU - Feig, Barry W.

AU - Sahin, Aysegul A.

AU - Perkins, George H.

AU - Babiera, Gildy

AU - Hortobagyi, Gabriel N.

AU - Buchholz, Thomas A.

PY - 2005/2/15

Y1 - 2005/2/15

N2 - BACKGROUND. The appropriate selection criteria for breast-conserving therapy (BCT) after neoadjuvant chemotherapy are poorly defined. The purpose of the current report was to develop a prognostic index to help refine selection criteria and to serve as a general framework for clinical decision-making for patients treated by this multimodality approach. METHODS. From a group of 340 patients treated with BCT after neoadjuvant chemotherapy, the authors previously determined 4 statistically significant predictors of ipsilateral breast tumor recurrence (IBTR) and locoregional recurrence (LRR): clinical N2 or N3 disease, residual pathologic tumor size > than 2 cm, a multifocal pattern of residual disease, and lymphovascular space invasion in the specimen. The M. D. Anderson Prognostic Index (MDAPI) was developed by assigning scores of 0 (favorable) or 1 (unfavorable) for each of these 4 variables and using the total to give an overall MDAPI score of 0-4. RESULTS. The MDAPI stratified the 340 patients into 3 subsets with statistically different levels of risk for IBTR and LRR after neoadjuvant chemotherapy and BCT. Actuarial 5-year IBTR-free survival rates were 97%, 88%, and 82% for patients in the low (MDAPI overall score 0 or 1, n = 276), intermediate (MDAPI score 2, n = 43), and high (MDAPI score 3 or 4, n = 12) risk groups, respectively (P < 0.001). Corresponding actuarial 5-year LRR-free survival rates were 94%, 83%, and 58%, respectively (P < 0.001). CONCLUSIONS. Patients with an MDAPI score of 0 or 1, which made up 81% of the study population, had very low rates of IBTR and LRR. The MDAPI enabled the identification of a small group (4%) of patients who are at high risk for IBTR and LRR and who may benefit from alternative locoregional treatment strategies.

AB - BACKGROUND. The appropriate selection criteria for breast-conserving therapy (BCT) after neoadjuvant chemotherapy are poorly defined. The purpose of the current report was to develop a prognostic index to help refine selection criteria and to serve as a general framework for clinical decision-making for patients treated by this multimodality approach. METHODS. From a group of 340 patients treated with BCT after neoadjuvant chemotherapy, the authors previously determined 4 statistically significant predictors of ipsilateral breast tumor recurrence (IBTR) and locoregional recurrence (LRR): clinical N2 or N3 disease, residual pathologic tumor size > than 2 cm, a multifocal pattern of residual disease, and lymphovascular space invasion in the specimen. The M. D. Anderson Prognostic Index (MDAPI) was developed by assigning scores of 0 (favorable) or 1 (unfavorable) for each of these 4 variables and using the total to give an overall MDAPI score of 0-4. RESULTS. The MDAPI stratified the 340 patients into 3 subsets with statistically different levels of risk for IBTR and LRR after neoadjuvant chemotherapy and BCT. Actuarial 5-year IBTR-free survival rates were 97%, 88%, and 82% for patients in the low (MDAPI overall score 0 or 1, n = 276), intermediate (MDAPI score 2, n = 43), and high (MDAPI score 3 or 4, n = 12) risk groups, respectively (P < 0.001). Corresponding actuarial 5-year LRR-free survival rates were 94%, 83%, and 58%, respectively (P < 0.001). CONCLUSIONS. Patients with an MDAPI score of 0 or 1, which made up 81% of the study population, had very low rates of IBTR and LRR. The MDAPI enabled the identification of a small group (4%) of patients who are at high risk for IBTR and LRR and who may benefit from alternative locoregional treatment strategies.

KW - Breast conservation

KW - Ipsilateral breast tumor

KW - Neoadjuvant chemotherapy

KW - Prognostic index

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