Distinct Prognosis of Minimal Residual Disease According to Breast Cancer Subtype in Patients with Breast or Nodal Pathologic Complete Response After Neoadjuvant Chemotherapy

PurposeFew studies have reported on patient prognosis according to residual cancer burden after neoadjuvant chemotherapy (NAC). Herein, we evaluated the survival of patients based on residual disease after NAC to identify subpopulations with distinct prognoses.MethodsWe retrospectively reviewed 728 patients treated with NAC from 2010 to 2017. Patients were divided into four subgroups depending on post-surgical residual disease according to the staging system: pathological complete response (pCR) (ypT0/TisN0), minimal residual disease (MRD) (ypT1mi/T1aN0 or ypT0/Tis ypN0i+/N1mic), node-only pCR (& GE; ypT1b ypN0), and breast-only pCR (ypT0/Tis & GE; ypN1a). Clinicopathological characteristics and survival outcomes were analyzed by adjusting for factors affecting survival.ResultsOverall, 50.4% (n = 367) of patients achieved pCR, with the MRD group accounting for 16.5% (n = 120). Although age and clinical stage were not different among the study groups, histologic grade, subtypes, chemotherapy response, and local treatment showed differences. Event-free survival (EFS) and overall survival (OS) demonstrated no significant difference between the pCR and MRD groups. In the multivariate analysis, pCR status was the only significant factor in EFS, and no statistical difference was noted between the pCR and MRD groups. However, clinical stage, pCR status, and subtype significantly affected the OS. MRD showed favorable outcomes in terms of both EFS and OS in all subtypes, except for those with triple-negative breast cancer (TNBC).ConclusionPatients with MRD showed outcomes comparable to those of patients who achieved pCR and may be candidates for de-escalation of post-NAC treatment, except for those with a TNBC subtype.

Automated summary

This study evaluated the impact of residual disease on patient prognosis after neoadjuvant chemotherapy (NAC) and analyzed subpopulations with different prognoses. The results showed that there was no significant difference in event-free survival and overall survival between the minimal residual disease (MRD) group and the pathological complete response (pCR) group, except for the triple-negative breast cancer subtype. Therefore, patients with MRD may be considered for de-escalation of post-NAC treatment.