A new histological grading system to assess response of XXXX to primary chemotherapy: prognostic significance and survival.

@entity1 @entity440 @entity5 @entity0
The clinical and complete pathological response of a primary @entity0 to chemotherapy has been shown to be an important prognostic for survival. However, the majority of @entity1 do not experience a complete pathological response to primary chemotherapy and the significance of lesser degrees of histological response is uncertain and the prognostic significance is unknown. The purpose of this study was to evaluate a new histological grading system to assess response of @entity0 to primary chemotherapy and to determine if such a system has prognostic value.A consecutive series of 176 @entity1 with large (> or =4cm) and locally advanced @entity0 were treated with multimodality therapy comprising primary chemotherapy, surgery, radiotherapy and @entity440 . All underwent assessment of the primary @entity0 before and after completion of chemotherapy. @entity5 was excised after completion of chemotherapy (mastectomy or wide local excision with axillary surgery). The removed tissue was assessed and response to chemotherapy graded using a five-point histological grading system based with the fundamental feature being a reduction in @entity5 cellularity; comparison being made with a pre-treatment core biopsy. All @entity1 were followed up for 5 years or more. Pathological responses were compared to 5 year overall survival and disease-free survival using log rank tests. The overall 5-year survival for all @entity1 was 71%, and 5 year disease free interval was 60%. There was a significant correlation between pathological response using this new grading system and both overall survival (P=0.02) and disease-free interval (P=0.04). In a multivariate analysis of known prognostic factors, the Miller/Payne grading system was an independent predictor of overall @entity1 survival. This grading system, which assesses the histological response to primary chemotherapy, can predict overall survival and disease-free interval in @entity1 with large and locally advanced @entity0 treated with such therapy. The relationship of degree of histological response to overall and disease-free survival has been shown in univariate and multivariate analyses and could potentially have an important role in the clinical management of @entity1 with locally advanced @entity0 undergoing primary chemotherapy.
