Predictive Factors of Breast Cancer Specific Survival of Patients Who Received Neoadjuvant Chemotherapy

Abstract

Neoadjuvant Chemotherapy (NAC) is a safe and effective therapeutic approach for larger primary and locally advanced breast cancer. The objective of this study was to determine the factors predicting the survival of breast cancer patients who received NAC and underwent surgical treatment.This retrospective study included all breast cancer patients who received NAC and had sought the services of the Immunohistochemistry Laboratory in the Faculty of Medicine, Galle from May 2006 to December 2012. Data was collected through follow up visits, clinic and laboratory records. Degree of down staging was estimated using clinical and pathological stage of the tumour. Breast Cancer Specific Survival (BCSS) and Recurrence Free Survival (RFS) rates were estimated using Kaplan-Meier model. Cox regression model was used for multivariate analysis. This study comprised of 164 patients. Five year BCSS of patients who received NAC was 63% and RFS was 59%. Only 2% had pathological complete response following NAC. Nodal down-staging (19%) was less prevalent than tumour down-staging (80%). Down-staging by overall TNM group was seen in 71.4%. There was no statistically significant difference in RFS or BCSS in terms of degree of down-staging. In the multivariate analysis, the presence of lympho-vascular invasion(LVI), negative progesterone receptor(PR) status and pathological stage following NAC were found to affect the BCSS (p<0.05) while the initial clinical stage did not have an effect (p>0.05).This study indicates that degree of down-staging by NAC does not influence the RFS or BCSS. The presence of LVI, expression of PR and the final pathological stage predict the BCSS of patients who received NAC but not the initial clinical stage.