Journal article
Is Multifocal Regression a Risk Factor for Ipsilateral Breast Tumor Recurrence in the Modern Era After Neoadjuvant Chemotherapy and Breast Conservation Therapy?
International journal of radiation oncology, biology, physics, v 104(4), pp 869-876
15 Jul 2019
PMID: 30885777
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Multifocal pattern of regression after neoadjuvant chemotherapy has been identified as a risk factor for ipsilateral breast tumor recurrence (IBTR). We aimed to determine the significance of multifocal regression as a predictor of IBTR after neoadjuvant chemotherapy and breast conservation therapy in the modern era.
We retrospectively reviewed 346 patients treated between November 2009 and June 2017. Pattern of regression was categorized as pathologic complete response (pCR), unifocal (tumor present as a cohesive mass), limited multifocal (single cells or clusters of cells concentrated in 1 portion of the fibrotic area), or diffuse multifocal (cells spread over entire fibrotic area). IBTR was defined as new ipsilateral invasive or noninvasive breast tumor after breast conservation therapy. Predictive factors were analyzed using Cox regression.
Incidence of multifocal regression was 25.7% for the overall cohort and 12.2% for estrogen receptor (ER) negative/progesterone receptor (PR) negative/human epidermal growth factor receptor 2 (HER2) positive, 17.5% for triple-negative, 36.9% for ER+ or PR+/HER2-, and 38.5% for triple-positive (P < .001). With a median follow-up of 41.1 months, 4-year IBTR-free survival after pCR or unifocal regression versus multifocal regression was 94.1% versus 90.9% (P = .411). Pattern of regression (P = .010; compared to pCR, hazard ratio [HR] of 11.2 for diffuse multifocal regression, 1.65 for limited multifocal regression, and 3.81 for unifocal regression), phenotype (P = .001; compared to ER+ or PR+/HER2-, HR of 30.67 for ER-/PR-/HER2+, 25.30 for triple-negative, and 1.60 for triple-positive), and lack of nodal pCR (P = .004; HR of 3.78) predicted for IBTR on multivariate Cox regression. On multivariate subset analysis, pattern of regression and lymphovascular space invasion predicted for IBTR in hormone receptor-negative patients, but pattern of regression was not associated with IBTR for hormone receptor-positive patients.
Multifocal regression, hormone receptor-negative phenotype, and lack of nodal pCR predict for increased risk of IBTR after neoadjuvant chemotherapy. Although more common in hormone receptor-positive disease, multifocal regression was associated with worse outcome only in hormone receptor-negative patients.
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Details
- Title
- Is Multifocal Regression a Risk Factor for Ipsilateral Breast Tumor Recurrence in the Modern Era After Neoadjuvant Chemotherapy and Breast Conservation Therapy?
- Creators
- Diane C Ling - UPMC Hillman Cancer CenterPhilip A Sutera - University of Pittsburgh Medical CenterNick A Iarrobino - University of Pittsburgh Medical CenterEmilia J Diego - Magee-Womens HospitalAtilla Soran - Magee-Womens HospitalRonald R Johnson - Magee-Womens HospitalRohit Bhargava - Magee-Womens HospitalColin E Champ - University of Pittsburgh Medical CenterSushil Beriwal - University of Pittsburgh Medical Center
- Publication Details
- International journal of radiation oncology, biology, physics, v 104(4), pp 869-876
- Publisher
- Elsevier
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Radiation Oncology (and Nuclear Medicine)
- Web of Science ID
- WOS:000471624800030
- Scopus ID
- 2-s2.0-85064228757
- Other Identifier
- 991021897385304721
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InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Web of Science research areas
- Oncology
- Radiology, Nuclear Medicine & Medical Imaging