Tumor biology correlates with rates of breastconserving surgery and pathologic complete response after neoadjuvant chemotherapy for breast cancer findings from the ACOSOG Z1071 (alliance) prospective multicenter clinical trial

Judy C. Boughey, Linda M. McCall, Karla V. Ballman, Elizabeth A. Mittendorf, Gretchen M. Ahrendt, Lee G. Wilke, Bret Taback, A. Marilyn Leitch, Teresa FlippoMorton, Kelly K. Hunt

Research output: Contribution to journalArticle

114 Citations (Scopus)

Abstract

Objective: To determine the impact of tumor biology on rates of breastconserving surgery and pathologic complete response (pCR) after neoadjuvant chemotherapy. Copyright

Background: The impact of tumor biology on the rate of breastconserving surgery after neoadjuvant chemotherapy has not been well studied.

Methods: We used data from ACOSOG Z1071, a prospective, multicenter study assessing sentinel lymph node surgery after neoadjuvant chemotherapy in patients presenting with nodepositive breast cancer from 2009 through 2011, to determine rates of breastconserving surgery and pCR after chemotherapy by approximated biologic subtype.

Results: Of the 756 patients enrolled on Z1071, 694 had findings available from pathologic review of breast and axillary specimens from surgery after chemotherapy. Approximated subtype was triplenegative in 170 (24.5%), human epidermal growth factor receptor 2 (HER2)positive in 207 (29.8%), and hormonereceptorpositive, HER2negative in 317 (45.7%) patients. Patient age, clinical tumor and nodal stage at presentation did not differ across subtypes. Rates of breastconserving surgery were significantly higher in patients with triplenegative (46.8%) and HER2positive tumors (43.0%) than in those with hormonereceptorpositive, HER2negative tumors (34.5%) (P = 0.019). Rates of pCR in both the breast and axilla were 38.2% in triplenegative, 45.4% in HER2positive, and 11.4% in hormonereceptorpositive, HER2negative disease (P 0.0001). Rates of pCR in the breast only and the axilla only exhibited similar differences across tumor subtypes.

Conclusions: Patients with triplenegative and HER2positive breast cancers have the highest rates of breastconserving surgery and pCR after neoadjuvant chemotherapy. Patients with these subtypes are most likely to be candidates for less invasive surgical approaches after chemotherapy.

Original languageEnglish (US)
Pages (from-to)608-616
Number of pages9
JournalAnnals of Surgery
Volume260
Issue number4
DOIs
StatePublished - 2014

Fingerprint

Multicenter Studies
Clinical Trials
Breast Neoplasms
Drug Therapy
Neoplasms
Axilla
Breast
Prospective Studies

Keywords

  • Breast cancer
  • Breast conservation
  • Neoadjuvant chemotherapy
  • Tumor subtype

ASJC Scopus subject areas

  • Surgery

Cite this

Tumor biology correlates with rates of breastconserving surgery and pathologic complete response after neoadjuvant chemotherapy for breast cancer findings from the ACOSOG Z1071 (alliance) prospective multicenter clinical trial. / Boughey, Judy C.; McCall, Linda M.; Ballman, Karla V.; Mittendorf, Elizabeth A.; Ahrendt, Gretchen M.; Wilke, Lee G.; Taback, Bret; Leitch, A. Marilyn; FlippoMorton, Teresa; Hunt, Kelly K.

In: Annals of Surgery, Vol. 260, No. 4, 2014, p. 608-616.

Research output: Contribution to journalArticle

Boughey, Judy C. ; McCall, Linda M. ; Ballman, Karla V. ; Mittendorf, Elizabeth A. ; Ahrendt, Gretchen M. ; Wilke, Lee G. ; Taback, Bret ; Leitch, A. Marilyn ; FlippoMorton, Teresa ; Hunt, Kelly K. / Tumor biology correlates with rates of breastconserving surgery and pathologic complete response after neoadjuvant chemotherapy for breast cancer findings from the ACOSOG Z1071 (alliance) prospective multicenter clinical trial. In: Annals of Surgery. 2014 ; Vol. 260, No. 4. pp. 608-616.
@article{29a3d98a1a9e45d98c0244ceb352ed5d,
title = "Tumor biology correlates with rates of breastconserving surgery and pathologic complete response after neoadjuvant chemotherapy for breast cancer findings from the ACOSOG Z1071 (alliance) prospective multicenter clinical trial",
abstract = "Objective: To determine the impact of tumor biology on rates of breastconserving surgery and pathologic complete response (pCR) after neoadjuvant chemotherapy. CopyrightBackground: The impact of tumor biology on the rate of breastconserving surgery after neoadjuvant chemotherapy has not been well studied.Methods: We used data from ACOSOG Z1071, a prospective, multicenter study assessing sentinel lymph node surgery after neoadjuvant chemotherapy in patients presenting with nodepositive breast cancer from 2009 through 2011, to determine rates of breastconserving surgery and pCR after chemotherapy by approximated biologic subtype.Results: Of the 756 patients enrolled on Z1071, 694 had findings available from pathologic review of breast and axillary specimens from surgery after chemotherapy. Approximated subtype was triplenegative in 170 (24.5{\%}), human epidermal growth factor receptor 2 (HER2)positive in 207 (29.8{\%}), and hormonereceptorpositive, HER2negative in 317 (45.7{\%}) patients. Patient age, clinical tumor and nodal stage at presentation did not differ across subtypes. Rates of breastconserving surgery were significantly higher in patients with triplenegative (46.8{\%}) and HER2positive tumors (43.0{\%}) than in those with hormonereceptorpositive, HER2negative tumors (34.5{\%}) (P = 0.019). Rates of pCR in both the breast and axilla were 38.2{\%} in triplenegative, 45.4{\%} in HER2positive, and 11.4{\%} in hormonereceptorpositive, HER2negative disease (P 0.0001). Rates of pCR in the breast only and the axilla only exhibited similar differences across tumor subtypes.Conclusions: Patients with triplenegative and HER2positive breast cancers have the highest rates of breastconserving surgery and pCR after neoadjuvant chemotherapy. Patients with these subtypes are most likely to be candidates for less invasive surgical approaches after chemotherapy.",
keywords = "Breast cancer, Breast conservation, Neoadjuvant chemotherapy, Tumor subtype",
author = "Boughey, {Judy C.} and McCall, {Linda M.} and Ballman, {Karla V.} and Mittendorf, {Elizabeth A.} and Ahrendt, {Gretchen M.} and Wilke, {Lee G.} and Bret Taback and Leitch, {A. Marilyn} and Teresa FlippoMorton and Hunt, {Kelly K.}",
year = "2014",
doi = "10.1097/SLA.0000000000000924",
language = "English (US)",
volume = "260",
pages = "608--616",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Tumor biology correlates with rates of breastconserving surgery and pathologic complete response after neoadjuvant chemotherapy for breast cancer findings from the ACOSOG Z1071 (alliance) prospective multicenter clinical trial

AU - Boughey, Judy C.

AU - McCall, Linda M.

AU - Ballman, Karla V.

AU - Mittendorf, Elizabeth A.

AU - Ahrendt, Gretchen M.

AU - Wilke, Lee G.

AU - Taback, Bret

AU - Leitch, A. Marilyn

AU - FlippoMorton, Teresa

AU - Hunt, Kelly K.

PY - 2014

Y1 - 2014

N2 - Objective: To determine the impact of tumor biology on rates of breastconserving surgery and pathologic complete response (pCR) after neoadjuvant chemotherapy. CopyrightBackground: The impact of tumor biology on the rate of breastconserving surgery after neoadjuvant chemotherapy has not been well studied.Methods: We used data from ACOSOG Z1071, a prospective, multicenter study assessing sentinel lymph node surgery after neoadjuvant chemotherapy in patients presenting with nodepositive breast cancer from 2009 through 2011, to determine rates of breastconserving surgery and pCR after chemotherapy by approximated biologic subtype.Results: Of the 756 patients enrolled on Z1071, 694 had findings available from pathologic review of breast and axillary specimens from surgery after chemotherapy. Approximated subtype was triplenegative in 170 (24.5%), human epidermal growth factor receptor 2 (HER2)positive in 207 (29.8%), and hormonereceptorpositive, HER2negative in 317 (45.7%) patients. Patient age, clinical tumor and nodal stage at presentation did not differ across subtypes. Rates of breastconserving surgery were significantly higher in patients with triplenegative (46.8%) and HER2positive tumors (43.0%) than in those with hormonereceptorpositive, HER2negative tumors (34.5%) (P = 0.019). Rates of pCR in both the breast and axilla were 38.2% in triplenegative, 45.4% in HER2positive, and 11.4% in hormonereceptorpositive, HER2negative disease (P 0.0001). Rates of pCR in the breast only and the axilla only exhibited similar differences across tumor subtypes.Conclusions: Patients with triplenegative and HER2positive breast cancers have the highest rates of breastconserving surgery and pCR after neoadjuvant chemotherapy. Patients with these subtypes are most likely to be candidates for less invasive surgical approaches after chemotherapy.

AB - Objective: To determine the impact of tumor biology on rates of breastconserving surgery and pathologic complete response (pCR) after neoadjuvant chemotherapy. CopyrightBackground: The impact of tumor biology on the rate of breastconserving surgery after neoadjuvant chemotherapy has not been well studied.Methods: We used data from ACOSOG Z1071, a prospective, multicenter study assessing sentinel lymph node surgery after neoadjuvant chemotherapy in patients presenting with nodepositive breast cancer from 2009 through 2011, to determine rates of breastconserving surgery and pCR after chemotherapy by approximated biologic subtype.Results: Of the 756 patients enrolled on Z1071, 694 had findings available from pathologic review of breast and axillary specimens from surgery after chemotherapy. Approximated subtype was triplenegative in 170 (24.5%), human epidermal growth factor receptor 2 (HER2)positive in 207 (29.8%), and hormonereceptorpositive, HER2negative in 317 (45.7%) patients. Patient age, clinical tumor and nodal stage at presentation did not differ across subtypes. Rates of breastconserving surgery were significantly higher in patients with triplenegative (46.8%) and HER2positive tumors (43.0%) than in those with hormonereceptorpositive, HER2negative tumors (34.5%) (P = 0.019). Rates of pCR in both the breast and axilla were 38.2% in triplenegative, 45.4% in HER2positive, and 11.4% in hormonereceptorpositive, HER2negative disease (P 0.0001). Rates of pCR in the breast only and the axilla only exhibited similar differences across tumor subtypes.Conclusions: Patients with triplenegative and HER2positive breast cancers have the highest rates of breastconserving surgery and pCR after neoadjuvant chemotherapy. Patients with these subtypes are most likely to be candidates for less invasive surgical approaches after chemotherapy.

KW - Breast cancer

KW - Breast conservation

KW - Neoadjuvant chemotherapy

KW - Tumor subtype

UR - http://www.scopus.com/inward/record.url?scp=84908391638&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84908391638&partnerID=8YFLogxK

U2 - 10.1097/SLA.0000000000000924

DO - 10.1097/SLA.0000000000000924

M3 - Article

VL - 260

SP - 608

EP - 616

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 4

ER -