Prognostic Significance of Inner Quadrant Involvement in Breast Cancer Treated with Neoadjuvant Chemotherapy.
10.4048/jbc.2016.19.4.394
- Author:
Ji Hyun CHANG
1
;
Wan JEON
;
Kyubo KIM
;
Kyung Hwan SHIN
;
Wonshik HAN
;
Dong Young NOH
;
Seock Ah IM
;
Tae You KIM
;
Yung Jue BANG
Author Information
1. Department of Radiation Oncology, SMG-SNU Boramae Medical Center, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
Breast neoplasms;
Neoadjuvant therapy;
Prognosis;
Tumor location
- MeSH:
Breast Neoplasms*;
Breast*;
Chemotherapy, Adjuvant;
Disease-Free Survival;
Drug Therapy*;
Follow-Up Studies;
Humans;
Mastectomy, Modified Radical;
Mastectomy, Segmental;
Neoadjuvant Therapy;
Prognosis;
Radiotherapy, Adjuvant;
Survival Rate
- From:Journal of Breast Cancer
2016;19(4):394-401
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: In the present study, we aimed to evaluate the initial tumor location as a prognostic factor in breast cancer patients treated with neoadjuvant chemotherapy (NAC). METHODS: Between March 2002 and January 2007, a total of 179 patients with stage II/III breast cancer underwent NAC followed by breast surgery. Using physical and radiologic findings, patients were grouped by their initial tumor location into inner/both quadrant (upper/lower inner quadrant involvement +/− multicentric tumor involving outer quadrant; n=97) and outer quadrant (n=82) tumor groups. All patients received neoadjuvant docetaxel/doxorubicin chemotherapy. One hundred two patients underwent modified radical mastectomy and 77 patients underwent breast-conserving surgery. Adjuvant radiotherapy (RT) and hormonal therapy were administered after surgery when indicated. While 156 patients underwent postoperative RT, 23 did not. The median follow-up duration was 61.1 (12–106) months. RESULTS: The 5-year disease-free survival (DFS) and overall survival rates of all patients were 74.8% and 89.9%, respectively. Patients with inner/both quadrant tumors had lower 5-year DFS than those with outer quadrant tumors (67.7% vs. 83.4%, respectively; hazard ratio [HR]=1.941, p=0.034). A nodal ratio >25% was also an independent adverse prognostic factor for DFS (HR=3.276; p<0.001). There was no significant difference in DFS (p=0.592) after RT on the internal mammary node (IMN). Treatment failed in 44 out of 179 patients (24.6%), of which 27 patients had inner/both quadrant tumors. Twenty-one out of 27 patients had distant failures. CONCLUSION: Among breast cancer patients treated with NAC, those with inner/both quadrant tumors had lower DFS than those with outer quadrant tumors. More aggressive neoadjuvant and/or adjuvant chemotherapy with IMN RT is required for improved disease control and long-term survival.
