Response to neoadjuvant chemotherapy based on pathologic complete response in very young patients with ER-positive breast cancer: a large, multicenter, observational study.
BACKGROUND
In estrogen receptor (ER)-positive breast cancer (BC), young age is associated with poor prognosis. While very young patients respond better to chemotherapy, chemotherapy is less effective in ER-positive tumors than in ER-negative tumors. The authors tried to evaluate chemotherapy response of very young patients with ER-positive BC by pathologic complete response (pCR) after neoadjuvant chemotherapy excluding the effect of endocrine treatment to the extent possible.


METHODS
We collected individual patient data from 1992 to 2013 from the Korean Breast Cancer Society (KBCS). Total 1048 ER-positive and 797 ER-negative patients aged < 50 years who had been treated with neoadjuvant chemotherapy were included for analysis. We compared pCR rate between patients aged < 35 years with ER-positive tumors and the other groups.


RESULTS
The proportion of patients aged < 35 years was 14.0% of patients with ER-positive BC in this cohort of under 50 years old, and 16.8% of patients with ER-negative BC in this cohort of under 50 years old. Although most characteristics of tumors according to age were comparable, tumors with high Ki-67 expression were more common in patients aged < 35 years than in patients aged 35-49 years in both ER-positive and -negative group (P = 0.001). Breast conservation rates were not significantly different according to age (44.2% vs. 46.8% in ER-positive group, 55.2% vs. 48.0% in ER-negative group). pCR rate was not different according to age in ER-positive group (P = 0.71) but significantly better in patients aged < 35 years in ER-negative group (P = 0.009). After adjusting for confounding variables, young patients maintained the higher probability of pCR than older patients in ER-negative tumors. However, pCR rate did not differ according to age in ER-positive tumors. In multivariate analysis, young age (< 35 years) was correlated with poor overall survival (P = 0.003, HR = 1.98) and there was only one event in a few patients achieved pCR in ER-positive group.


CONCLUSIONS
Chemotherapy response based on pCR was not better in young patients (< 35 years) with ER-positive BC than in older premenopausal patients with non-metastatic ER-positive BC. Young age cannot be a predictive factor of response to neoadjuvant chemotherapy in ER-positive BC. Different biological characteristics such as high proliferative index should be considered.


TRIAL REGISTRATION
Retrospectively registered.
['Woo|Joohyun|J|', 'Oh|Se Jeong|SJ|', 'Song|Jeong-Yoon|JY|', 'Chae|Byung Joo|BJ|', 'Choi|Jung Eun|JE|', 'Lee|Jeeyeon|J|', 'Park|Heung Kyu|HK|', '|||', 'Lim|Woosung|W|http://orcid.org/0000-0002-2863-9346']
D000328:Adult D000367:Age Factors D000971:Antineoplastic Combined Chemotherapy Protocols D014408:Biomarkers, Tumor D001940:Breast D001943:Breast Neoplasms D005260:Female D006801:Humans D053208:Kaplan-Meier Estimate D008408:Mastectomy D008875:Middle Aged D020360:Neoadjuvant Therapy D011379:Prognosis D011960:Receptors, Estrogen D016896:Treatment Outcome
Neoadjuvant chemotherapy Pathologic complete response Young patients ER-positive Breast cancer