Nottingham Clinico-Pathological Response Index (NPRI) after Neoadjuvant Chemotherapy (Neo-ACT) Accurately Predicts Clinical Outcome in Locally Advanced Breast Cancer

Abdel-Fatah, TM, Ball, G ORCID: 0000-0001-5828-7129, Lee, AHS, Pinder, S, MacMilan, RD, Cornford, E, Moseley, PM, Silverman, R, Price, J, Latham, B, Palmer, D, Chan, A, Ellis, IO and Chan, SYT, 2015. Nottingham Clinico-Pathological Response Index (NPRI) after Neoadjuvant Chemotherapy (Neo-ACT) Accurately Predicts Clinical Outcome in Locally Advanced Breast Cancer. Clinical Cancer Research, 21 (5), pp. 1052-1062. ISSN 1078-0432

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Purpose: There is a need to identify more sensitive clinico-pathological criteria to assess the response to Neo-ACT and guide subsequent adjuvant-therapy. Experimental Design: We performed a clinico-pathological assessment of 427 patients who had completed Neo-ACT for locally advanced breast cancer (LABC) with a median follow-up of 5-years. Patients were divided into a training set treated with anthracycline combination chemotherapy (AC, n=172); an internal validation set treated with AC and taxane (n=130); and an external validation set treated with AC with or without taxane (n=125). Results: A multivariate Cox regression model demonstrated the absence of fibrosis, presence of lympho-vascular invasion, and increasing number of lymph node metastases were significantly associated with short disease-free survival (DFS) and breast-cancer specific survival (BCSS, p<0.01), whilst reduction of tumour size was associated with DFS (p=0.022). Nottingham Clinico-Pathological Response Indexes (NPRIs) were calculated and four prognostic groups (NPRI-PGs) were identified. Patients in prognostic group 2 (NPRI-PG2) for DFS (n=63/172; 36.6%) and BCSS (66/172; 38.4%) have the same prognosis as those who achieved pCR (NPRI-PG1; 15%). Receiver operating characteristic (ROC) curves indicated that the NPRI outperformed the currently used prognostic factors and adding NPRI improved their performance as a predictor for both DFS (AUC=0.87) and BCSS (AUC= 0.88). Conclusions: The NPRI predicts DFS and BCSS, with a higher sensitivity than pCR. The NPRI can also improve the sensitivity and specificity of clinico-pathological response as a study end-point, for assessing response to Neo-ACT, and can serve as a valuable tool for the discovery of future predictive molecular markers.

Item Type: Journal article
Publication Title: Clinical Cancer Research
Creators: Abdel-Fatah, T.M., Ball, G., Lee, A.H.S., Pinder, S., MacMilan, R.D., Cornford, E., Moseley, P.M., Silverman, R., Price, J., Latham, B., Palmer, D., Chan, A., Ellis, I.O. and Chan, S.Y.T.
Publisher: American Association for Cancer Research
Date: 2015
Volume: 21
Number: 5
ISSN: 1078-0432
Divisions: Schools > School of Science and Technology
Depositing User: Jonathan Gallacher
Date Added: 09 Feb 2016 16:24
Last Modified: 09 Jun 2017 13:59

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