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Data shed light on recurrence patterns in breast, bowel cancer
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Age and tumor response after neoadjuvant chemotherapy were independent predictors of locoregional recurrence in a cohort of patients with breast and bowel cancer, according to study results.
Due to a paucity of information on locoregional recurrence after neoadjuvant chemotherapy in these two types of cancer, researchers examined patterns of this type of recurrence in a cohort of 3,088 patients.
Eleftherios P. Mamounas, MD, medical director of the Cancer Center at Aultman Hospital in Canton, Ohio, and colleagues culled the study population from two National Surgical Adjuvant Breast and Bowel Project trials.
Eligible participants had received doxorubicin/cyclophosphamide (AC) alone or AC followed by neoadjuvant/adjuvant docetaxel.
Patients in the lumpectomy group received breast radiotherapy alone, and those in the mastectomy group received no radiotherapy.
Researchers defined pathologic complete response as the absence of invasive tumor in the breast. Time to locoregional recurrence as first event served as the primary endpoint.
The researchers used multivariable analysis to calculate independent predictors of locoregional recurrence.
After 10 years of follow-up, 335 locoregional recurrence events had occurred, yielding a 10-year cumulative incidence rate of 12.3% for mastectomy patients (8.9% local; 3.4% regional) and 10.3% for lumpectomy plus breast radiotherapy patients (8.1% local; 2.2% regional).
The researchers identified age, clinical nodal status (before neoadjuvant chemotherapy) and pathologic nodal status/breast tumor response as prognostic factors for recurrence in lumpectomy patients. For mastectomy patients, factors that predicted occurrence included clinical tumor size (before neoadjuvant chemotherapy), clinical nodal status (before neoadjuvant chemotherapy) and pathologic nodal status/breast tumor response.
The prognostic factors may used to categorize patients as having low, intermediate or high risk of recurrence. The researchers then created nomograms that were used to incorporate the independent predictors. The nomograms must be validated in other independent data sets, the researchers said.
“It should be reiterated that results of this study apply only to patients with operable breast cancer at presentation, because patients with T4 or N2 disease at presentation were not eligible for these two trials,” Mamounas and colleagues wrote. “In fact, data on locoregional recurrence rates in patients with locally advanced breast cancer … suggest higher rates of locoregional recurrence, even with pathologic complete response to neoadjuvant chemotherapy.”
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