Surgical Pathology (Dermatopathology, Gynecologic, Head & Neck, Breast, Endocrine, Pediatrics, Pulmonary)/Friday Session 2, November 2, 2012 148
Clinicopathologic Factors Predictive of Distant Metastasis in Triple-Negative and Non–Triple-Negative Breast
Carcinomas Treated With Neoadjuvant Chemotherapy Followed by Surgery: A Comparative Multivariate
Analysis Study
Lei Duan, MD, PhD1, Jingsheng Yan, PhD2, Venetia Sarode, MD2, A. Marilyn Leitch, MD2, David Euhus, MD2, Roshni
Rao, MD2, Dengfeng Cao, MD3, Yan Peng, MD, PhD2
1
Beth Israel Deaconess Medical Center, Boston, MA, 2University of Texas Southwestern Medical, 3Washington University
at St Louis
Triple-negative (TN) breast carcinoma characterized by hormone receptor and HER2 negativity is associated with poor
prognosis. Neoadjuvant chemotherapy followed by surgery is commonly used to treat locally advanced breast cancer. In
this study, we attempted to identify independent risk factors for predicting disease progression in patients with TN and
high-grade non-TN tumors after the treatment of neoadjuvant chemotherapy followed by surgery. Clinical characteristics
and tumor profiles were analyzed in 106 patients with high-grade invasive carcinomas, including 41 TN and 65 non-TN
tumors. All of the patients developed distant metastasis after the treatment of chemotherapy followed by breast resection.
The tumor marker studies were done on the resected tumors in about two thirds of the patients. The patients were divided
into subgroups based on age (≤40 vs >40 years) and posttreatment tumor size (≤2 vs R2 cm) in the TN and non-TN
groups, respectively. Before the multivariate analysis, a univariate analysis was performed to select potential factors
predictive of distant metastasis in the patients. The univariate parameters included age, tumor size, grade, and Ki-67 and
p53 expression in both groups; additionally, EGFR, CK5/6, and CK14 expressions were added in the TN group and
positivity of ER, PR, and HER2 in the non-TN group. On multivariate analysis, the age and tumor size were significantly
correlated with distant metastasis in the TN tumors (P = .009, P = .008) but not in the non-TN tumors. The TN cancer
patients at age 40 years or younger or with a tumor more than 2 cm had significantly increased risk to develop distant
metastasis as compared with patients who were older than 40 years or with a tumor 2 cm or smaller. In the non-TN group,
posttreatment HER2 positivity was significantly correlated with distant metastasis (P = .014). Other factors did not reach
statistical significance in the groups. On Pearson correlation analysis, the percentage of posttreatment axillary positive
nodes was significantly associated with distant metastasis in these tumors (P = .016). Our results indicate that younger age
(≤40 years) and larger posttreatment tumor size (>2 cm) are independent predictors for disease progression in TN tumors
and persistent HER2 positivity in non-TN tumors in the setting of postneoadjuvant chemotherapy.
Category:
Surgical Pathology
©American Society for Clinical Pathology
Am J Clin Pathol 2012;138:A148