Elsevier

The Breast

Volume 40, August 2018, Pages 29-37
The Breast

Original article
Validation of the CPS+EG and Neo-Bioscore staging systems after preoperative systemic therapy for breast cancer in a single center in China

https://doi.org/10.1016/j.breast.2018.03.010Get rights and content

Abstract

Background

Prognostic assessment after preoperative systemic therapy (PST) plays a vital role in determining treatment in breast cancer patients. Many researchers have sought to develop a system to quantitate residual tumor and its correlation with prognosis after PST. This retrospective study validated the CPS + EG staging system and Neo-Bioscore in a single center in China.

Methods

Data from patients with non-metastatic primary breast cancer who were treated with PST and surgery from Jan. 2008 to Dec. 2014 at the Breast Disease Center of Peking University First Hospital, China, were reviewed. DFS, DSS and OS were calculated using the K-M curve and AUC. Multivariate analysis was used for a Cox proportional hazards model. All calculations were performed with SAS 9.4.

Results

A total of 403 patients were enrolled in this study. The median follow-up period was 45 (range 11–107) months. The five-year DFS, DSS and OS rates were 86.4%, 91.2% and 90.5%, respectively. The CS, PS, CPS + EG staging system and Neo-Bioscore stratified patients according to DFS, DSS, and OS after PST, with all P values < 0.0001. The CPS + EG staging system and Neo-Bioscore stratified prognosis after PST better than CS. HER2-positive patients without trastuzumab treatment had obviously worse DFS and OS than other subgroups with different HER2 statuses that scored a 3 in the Neo-Bioscore system.

Conclusions

The CPS + EG staging system and Neo-Bioscore can improve prognostic prediction in non-pCR breast cancer patients after PST and, provided unfavorable prognostic factors such as insufficient treatment are incorporated, will have broader clinical applicability.

Section snippets

Background

Preoperative systemic therapy (PST) or neoadjuvant chemotherapy (NAC) has become part of the standard treatment regimen for breast cancer patients with locally advanced disease and is increasingly being used in clinical practice. In addition to reducing tumor burden and thus permitting conservative breast surgery and fewer surgeries, PST provides a good opportunity to evaluate the response of breast cancer to systemic treatments. Numerous studies have demonstrated that the degree of reduction

Patient population

Data from 479 consecutive patients diagnosed with primary nonmetastatic breast cancer who underwent PST from Jan. 2008 to Dec. 2014 at the Breast Disease Center of Peking University First Hospital, China were retrospectively reviewed. All patients were diagnosed by core needle biopsy (CNB) of primary breast foci, and lymph nodes were evaluated by fine needle biopsy (FNB) if clinically positive or by sentinel lymph node biopsy (SLNB) if clinically or FNB-negative. From this cohort, 76 cases were

Patient characteristics

A total of 403 patients with complete data based on multiple staging systems were enrolled in this study. The characteristics of all 403 patients are listed in Table 2. The median age was 50 (range 22–74) years. The median follow-up period was 45 (range 11–107) months. Two patients (0.5%) were male. A total of 121 patients (30%) were HER2-positive, and 74 (61.2%) received trastuzumab combined with PST. A pCR was achieved in 22.3% (n = 90) of patients in the overall cohort.

The distribution of

Discussion

In our study, the CPS + EG and Neo-Bioscore scoring systems were validated for their ability to stratify breast cancer patients after PST according to prognosis. More importantly, the prognostic predictions were investigated not only for DSS but also for DFS and OS. The CPS + EG score and Neo-Bioscore staging systems were obviously better than CS. Although the HER2 status has been considered in the Neo-Bioscore staging system, generally speaking, no superiority was seen when this score was

Conflicts of interest

The authors declare no conflicts of interest.

Acknowledgements

The research leading to these results has received funding from the grant: National Key R&D Program of China (grant number: 2016YFC0901302).

References (24)

  • E.H. Romond et al.

    Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer

    N Engl J Med

    (2005)
  • E.A. Mittendorf et al.

    Loss of HER2 amplification following trastuzumab-based neoadjuvant systemic therapy and survival outcomes

    Clin Canc Res

    (2009)
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