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Outcome prediction for estrogen receptor-positive breast cancer based on postneoadjuvant endocrine therapy tumor characteristics.
J Natl Cancer Inst. 2008 Oct 01; 100(19):1380-8.JNCI

Abstract

BACKGROUND

Understanding how tumor response is related to relapse risk would help clinicians make decisions about additional treatment options for patients who have received neoadjuvant endocrine treatment for estrogen receptor-positive (ER+) breast cancer.

METHODS

Tumors from 228 postmenopausal women with confirmed ER+ stage 2 and 3 breast cancers in the P024 neoadjuvant endocrine therapy trial, which compared letrozole and tamoxifen for 4 months before surgery, were analyzed for posttreatment ER status, Ki67 proliferation index, histological grade, pathological tumor size, node status, and treatment response. Cox proportional hazards were used to identify factors associated with relapse-free survival (RFS) and breast cancer-specific survival (BCSS) in 158 women. A preoperative endocrine prognostic index (PEPI) for RFS was developed from these data and validated in an independent study of 203 postmenopausal women in the IMPACT trial, which compared treatment with anastrozole, tamoxifen, or the combination 3 months before surgery. Statistical tests were two-sided.

RESULTS

Median follow-up in P024 was 61.2 months. Patients with confirmed baseline ER+ clinical stage 2 and 3 tumors that were downstaged to stage 1 or 0 at surgery had 100% RFS (compared with higher stages, P < .001). Multivariable testing of posttreatment tumor characteristics revealed that pathological tumor size, node status, Ki67 level, and ER status were independently associated with both RFS and BCSS. The PEPI model based on these factors predicted RFS in the IMPACT trial (P = .002).

CONCLUSIONS

Breast cancer patients with pathological stage 1 or 0 disease after neoadjuvant endocrine therapy and a low-risk biomarker profile in the surgical specimen (PEPI score 0) have an extremely low risk of relapse and are therefore unlikely to benefit from adjuvant chemotherapy.

Authors+Show Affiliations

Siteman Cancer Center, Washington University School of Medicine, 660 South Euclid Ave, St Louis, MO 63119, USA. mellis@wustl.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

18812550

Citation

Ellis, Matthew J., et al. "Outcome Prediction for Estrogen Receptor-positive Breast Cancer Based On Postneoadjuvant Endocrine Therapy Tumor Characteristics." Journal of the National Cancer Institute, vol. 100, no. 19, 2008, pp. 1380-8.
Ellis MJ, Tao Y, Luo J, et al. Outcome prediction for estrogen receptor-positive breast cancer based on postneoadjuvant endocrine therapy tumor characteristics. J Natl Cancer Inst. 2008;100(19):1380-8.
Ellis, M. J., Tao, Y., Luo, J., A'Hern, R., Evans, D. B., Bhatnagar, A. S., Chaudri Ross, H. A., von Kameke, A., Miller, W. R., Smith, I., Eiermann, W., & Dowsett, M. (2008). Outcome prediction for estrogen receptor-positive breast cancer based on postneoadjuvant endocrine therapy tumor characteristics. Journal of the National Cancer Institute, 100(19), 1380-8. https://doi.org/10.1093/jnci/djn309
Ellis MJ, et al. Outcome Prediction for Estrogen Receptor-positive Breast Cancer Based On Postneoadjuvant Endocrine Therapy Tumor Characteristics. J Natl Cancer Inst. 2008 Oct 1;100(19):1380-8. PubMed PMID: 18812550.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcome prediction for estrogen receptor-positive breast cancer based on postneoadjuvant endocrine therapy tumor characteristics. AU - Ellis,Matthew J, AU - Tao,Yu, AU - Luo,Jingqin, AU - A'Hern,Roger, AU - Evans,Dean B, AU - Bhatnagar,Ajay S, AU - Chaudri Ross,Hilary A, AU - von Kameke,Alexander, AU - Miller,William R, AU - Smith,Ian, AU - Eiermann,Wolfgang, AU - Dowsett,Mitch, Y1 - 2008/09/23/ PY - 2008/9/25/pubmed PY - 2008/10/23/medline PY - 2008/9/25/entrez SP - 1380 EP - 8 JF - Journal of the National Cancer Institute JO - J Natl Cancer Inst VL - 100 IS - 19 N2 - BACKGROUND: Understanding how tumor response is related to relapse risk would help clinicians make decisions about additional treatment options for patients who have received neoadjuvant endocrine treatment for estrogen receptor-positive (ER+) breast cancer. METHODS: Tumors from 228 postmenopausal women with confirmed ER+ stage 2 and 3 breast cancers in the P024 neoadjuvant endocrine therapy trial, which compared letrozole and tamoxifen for 4 months before surgery, were analyzed for posttreatment ER status, Ki67 proliferation index, histological grade, pathological tumor size, node status, and treatment response. Cox proportional hazards were used to identify factors associated with relapse-free survival (RFS) and breast cancer-specific survival (BCSS) in 158 women. A preoperative endocrine prognostic index (PEPI) for RFS was developed from these data and validated in an independent study of 203 postmenopausal women in the IMPACT trial, which compared treatment with anastrozole, tamoxifen, or the combination 3 months before surgery. Statistical tests were two-sided. RESULTS: Median follow-up in P024 was 61.2 months. Patients with confirmed baseline ER+ clinical stage 2 and 3 tumors that were downstaged to stage 1 or 0 at surgery had 100% RFS (compared with higher stages, P < .001). Multivariable testing of posttreatment tumor characteristics revealed that pathological tumor size, node status, Ki67 level, and ER status were independently associated with both RFS and BCSS. The PEPI model based on these factors predicted RFS in the IMPACT trial (P = .002). CONCLUSIONS: Breast cancer patients with pathological stage 1 or 0 disease after neoadjuvant endocrine therapy and a low-risk biomarker profile in the surgical specimen (PEPI score 0) have an extremely low risk of relapse and are therefore unlikely to benefit from adjuvant chemotherapy. SN - 1460-2105 UR - https://www.unboundmedicine.com/medline/citation/18812550/Outcome_prediction_for_estrogen_receptor_positive_breast_cancer_based_on_postneoadjuvant_endocrine_therapy_tumor_characteristics_ L2 - https://academic.oup.com/jnci/article-lookup/doi/10.1093/jnci/djn309 DB - PRIME DP - Unbound Medicine ER -