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01-09-2019 | Mastectomy | Clinical trial

Locoregional risk assessment after neoadjuvant chemotherapy in patients with primary breast cancer: clinical utility of the CPS + EG score

Authors: Laura L. Michel, Laura Sommer, Rosa González Silos, Justo Lorenzo Bermejo, Alexandra von Au, Julia Seitz, André Hennigs, Katharina Smetanay, Michael Golatta, Jörg Heil, Florian Schütz, Christof Sohn, Andreas Schneeweiss, Frederik Marmé

Published in: Breast Cancer Research and Treatment | Issue 2/2019

Abstract

Purpose

Locoregional control is a prerequisite to cure primary breast cancer but the prediction of locoregional recurrence to guide further local therapy following neoadjuvant chemotherapy remains a challenge. The CPS + EG score was designed to predict distant recurrences. Here we examine its ability to predict both not only distant but also locoregional recurrences with respect to accuracy and clinical applicability.

Methods

Clinical data from 432 patients with primary breast cancer treated with neoadjuvant chemotherapy between 2003 and 2011 were prospectively collected. Using the Kaplan–Meier method we analyzed the risk of local and distant recurrences according to individual CPS + EG scores, stratified by type of surgery. Possible confounding of the relationship between recurrence risk and CPS + EG score by established risk factors was accounted for in multiple survival regression models. Additionally, we analyzed the performance of the CPS + EG score to predict isolated locoregional recurrence by censoring patients with prior or simultaneous distant metastases.

Results

5-year locoregional recurrence-free survival was 90%, and 5-year distant metastases-free survival was 82%. The CPS + EG score stratified patients into six prognostic groups with distinct 5-year locoregional recurrence-free survival, ranging from 100 to 41% (p = 0.02) and 5-year distant metastases-free survival, ranging from 96 to 35% (p < 0.0001). 8 patients (17%) with CPS + EG scores ≥ 4 experienced locoregional recurrence—5 of them presented with simultaneous distant disease.

Conclusion

The CPS + EG score, originally designed to predict distant relapse, is also valuable for assessing local recurrence risks. Our data demonstrate that distant and locoregional recurrence risks are closely related. As prognosis of patients with high risk of locoregional failure based on CPS + EG is dominated by distant recurrences, escalating local therapies may have limited impact on overall prognosis.

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Title: Locoregional risk assessment after neoadjuvant chemotherapy in patients with primary breast cancer: clinical utility of the CPS + EG score
Authors: Laura L. Michel
Laura Sommer
Rosa González Silos
Justo Lorenzo Bermejo
Alexandra von Au
Julia Seitz
André Hennigs
Katharina Smetanay
Michael Golatta
Jörg Heil
Florian Schütz
Christof Sohn
Andreas Schneeweiss
Frederik Marmé
Publication date: 01-09-2019
Publisher: Springer US
Keywords: Mastectomy
Breast Cancer
Breast Cancer
Cytostatic Therapy
Published in: Breast Cancer Research and Treatment / Issue 2/2019
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-019-05314-9

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