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Distinct Prognosis of Minimal Residual Disease According to Breast Cancer Subtype in Patients with Breast or Nodal Pathologic Complete Response After Neoadjuvant Chemotherapy

 Jieon Go  ;  Jee Hyun Ahn  ;  Jung Min Park  ;  Soon Bo Choi  ;  Jee Ye Kim  ;  Hyung Seok Park  ;  Seung Il Kim  ;  Byeong-Woo Park  ;  Seho Park 
 ANNALS OF SURGICAL ONCOLOGY, Vol.30(12) : 7060-7068, 2023-11 
Journal Title
Issue Date
Antineoplastic Combined Chemotherapy Protocols / therapeutic use ; Breast Neoplasms* / pathology ; Chemotherapy, Adjuvant ; Female ; Humans ; Neoadjuvant Therapy ; Neoplasm, Residual / pathology ; Prognosis ; Retrospective Studies ; Triple Negative Breast Neoplasms* / pathology
Breast cancer ; De-escalation ; Minimal residual disease ; Neoadjuvant chemotherapy ; Pathologic complete response ; Residual cancer burden
Purpose: Few studies have reported on patient prognosis according to residual cancer burden after neoadjuvant chemotherapy (NAC). Herein, we evaluated the survival of patients based on residual disease after NAC to identify subpopulations with distinct prognoses.

Methods: We retrospectively reviewed 728 patients treated with NAC from 2010 to 2017. Patients were divided into four subgroups depending on post-surgical residual disease according to the staging system: pathological complete response (pCR) (ypT0/TisN0), minimal residual disease (MRD) (ypT1mi/T1aN0 or ypT0/Tis ypN0i+/N1mic), node-only pCR (≥ ypT1b ypN0), and breast-only pCR (ypT0/Tis ≥ ypN1a). Clinicopathological characteristics and survival outcomes were analyzed by adjusting for factors affecting survival.

Results: Overall, 50.4% (n = 367) of patients achieved pCR, with the MRD group accounting for 16.5% (n = 120). Although age and clinical stage were not different among the study groups, histologic grade, subtypes, chemotherapy response, and local treatment showed differences. Event-free survival (EFS) and overall survival (OS) demonstrated no significant difference between the pCR and MRD groups. In the multivariate analysis, pCR status was the only significant factor in EFS, and no statistical difference was noted between the pCR and MRD groups. However, clinical stage, pCR status, and subtype significantly affected the OS. MRD showed favorable outcomes in terms of both EFS and OS in all subtypes, except for those with triple-negative breast cancer (TNBC).

Conclusion: Patients with MRD showed outcomes comparable to those of patients who achieved pCR and may be candidates for de-escalation of post-NAC treatment, except for those with a TNBC subtype.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Go, Jieon(고지언)
Kim, Seung Il(김승일)
Kim, Jee Ye(김지예) ORCID logo https://orcid.org/0000-0003-3936-4410
Park, Byeong Woo(박병우) ORCID logo https://orcid.org/0000-0003-1353-2607
Park, Se Ho(박세호) ORCID logo https://orcid.org/0000-0001-8089-2755
Park, Jung Min(박정민)
Park, Hyung Seok(박형석) ORCID logo https://orcid.org/0000-0001-5322-6036
Ahn, Jee Hyun(안지현)
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