# Neoadjuvant chemotherapy for breast cancer: Pathologic response rates but not tumor size, has an independent prognostic impact on survival

**Autores:** Gilles Houvenaeghel, Alexandre de Nonneville, Monique Cohen et al.
**Revista:** Cancer Med (2024)
**PMID:** 38327130 | **PMCID:** PMC10904968
**DOI:** [10.1002/cam4.6930](https://doi.org/10.1002/cam4.6930)
**Fuente:** PubMed Central (open access full-text)

## Relevancia
Cohorte francesa retrospectiva de 1150 pacientes con QT neoadyuvante (2005-2018). pCR del 31.7%, asociada a subtipo (no tamaño tumoral). La enfermedad ganglionar residual (ypN1) es el factor pronóstico negativo más potente (HR 3.15-6.13 para OS/RFS/MFS), superior incluso al efecto de no alcanzar pCR mamaria. Subraya la importancia clínica de la conversión a ypN0.

## Abstract
We investigated the pathologic complete response rates (pCR) and survival outcomes of early breast cancer patients who underwent neoadjuvant chemotherapy (NAC) over 14 years at a French comprehensive cancer center and reported pCR and survival outcomes by tumor subtypes and size.

From January 2005 to December 2018, 1150 patients receiving NAC were identified. Correlations between cT stage, breast tumor response, axillary lymph node response, pCR, surgery, and outcomes were assessed. pCR was defined as (ypT0/ypTis) and (ypN0/pN0sn).

A pCR was reached in 31.7% (365/1150) of patients and was strongly associated with tumor subtypes, but not with tumor size (pretreatment cT category). Luminal-B Her2-negative and triple-negative (TN) subtypes, cN1 status, older age, and no-pCR had an independent negative prognostic value. Overall survival (OS), relapse-free survival (RFS), and metastasis-free survival (MFS) were not significantly different for cT0-1 compared to cT2 stages. In Cox-model adjusted on in-breast pCR and pN status, ypN1 had a strong negative impact (OS, RFS, and MFS: HR=3.153, 4.677, and 6.133, respectively), higher than no in-breast pCR (HR=2.369, 2.252, and 2.323). A negative impact of no pCR on OS was observed for cN0 patients and TN tumors (HR=4.972) or HER2-positive tumors (HR=11.706), as well as in Luminal-B Her2-negative tumors on MFS (HR=2.223) and for Luminal-A on RFS (HR=4.465) and MFS (HR=4.185).

Achievement of pCR, but not tumor size (pretreatment cT category), has an independent prognostic impact on survival. These results suggest potential NAC benefits in patients with small tumors (<2 cm), even in absence of clinically suspicious lymph nodes. Residual lymph node disease after NAC is the most powerful adverse prognostic factor.

## Texto completo
Texto completo disponible en PMC: [PMC10904968](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10904968/). El estudio analiza 1150 pacientes con QT neoadyuvante en un centro francés. Demuestra que el status ganglionar residual (ypN1) es el factor pronóstico independiente más potente sobre OS, RFS y MFS, superior incluso a la respuesta tumoral en la mama. Apoya la priorización de la conversión ganglionar a ypN0 como objetivo central del tratamiento neoadyuvante y la importancia de una estadificación axilar precisa.

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*Datos de PubMed. Citar: doi 10.1002/cam4.6930*
