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ABSTRACT: Prognostic significance of a complete pathological response
after induction chemotherapy in operable breast cancer
Only a few papers have been published concerning the incidence
and outcome of patients with a pathological complete response
after cytotoxic treatment in breast cancer.
The purpose of this
retrospective study was to assess the outcome of patients found
to have a pathological complete response in both the breast and
axillary lymph nodes after neoadjuvant chemotherapy for operable
breast cancer.
Our goal was also to determine whether the residual
pathological size of the tumour in breast could be correlated
with pathological node status.
Between 1982 and 2000, 451 consecutive
patients were registered into five prospective phase II trials.
After six cycles, 396 patients underwent surgery with axillary
dissection for 277 patients (69.9%).
Pathological response was
evaluated according to the Chevallier's classification. At a median
follow-up of 8 years, survival was analysed as a function of
pathological response.
A pathological complete response rate was
obtained in 60 patients (15.2%) after induction chemotherapy.
Breast tumour persistence was significantly related to positive
axillary nodes (P=5.10^-6). At 15 years, overall survival and
disease-free survival rates were significantly higher in the
group who had a pathological complete response than in the group
who had less than a pathological complete response (P=0.047
and P=0.024, respectively).
In the absence of pathological complete
response and furthermore when there is a notable remaining
pathological disease, axillary dissection is still important
to determine a major prognostic factor and subsequently, a
second non cross resistant adjuvant regimen or high dose
chemotherapy could lead to a survival benefit.
[04/02/2002; British Journal of Cancer]
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