Date Published: January 31, 2019
Publisher: Public Library of Science
Author(s): 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, William B. Coleman.
Locoregional recurrence after neoadjuvant chemotherapy for primary breast cancer is associated with poor prognosis. It is essential to identify patients at high risk of locoregional recurrence who may benefit from extended local therapy. Here, we examined the prediction accuracy and clinical applicability of the MD Anderson Prognostic Index (MDAPI).
Prospective clinical data from 456 patients treated between 2003 and 2011 was analyzed. The Kaplan-Meier method was used to examine the probabilities of locoregional recurrence, local recurrence and distant metastases according to individual prognosis score, stratified by type of surgery (breast conserving therapy or mastectomy). The possible confounding of the relationship between recurrence risk and MDAPI by established risk factors was accounted for in multiple survival regression models. To define the clinical utility of the MDAPI we analyzed its performance to predict locoregional recurrence censoring patients with prior or simultaneous distant metastases.
Mastectomized patients (42% of the patients) presented with more advanced tumor stage, lower tumor grade, hormone-receptor positive disease and consequently lower pathological complete response rates. Only a few patients presented with high-risk scores (2,7% MDAPI≥3). All patients with high-risk MDAPI score (MDAPI ≥3) who developed locoregional recurrence were simultaneously affected by distant metastases.
Our data do not support a clinical utility of the MDAPI to guide local therapy.
Locoregional recurrence (LRR) is associated with poor overall survival (OS).[1,2] It is essential to identify patients at high risk of LRR that might benefit from more radical local treatment (e.g. mastectomy or extended radiation fields) but at the same time to avoid overtreatment.
456 patients matched all in- and exclusion criteria (Fig 1). Patient and tumor characteristics are summarized in Table 1. Median follow up was 59 months (range, 6–142 months). 264 patients (57.9%) were treated with BCT and 192 (42.1%) with ME.
In the present study we aimed to investigate the clinical utility of the MDAPI to guide local therapy based on a patient cohort as up-to-date and as large as possible. To ensure a patient follow-up of at least 5 years, we excluded all patients diagnosed after 2011.