Assessment of Clinico Pathological Factors as Predictive Markers in Response to Neoadjuvant Chemotherapy in Locally Advanced Breast Cancer (LABC)

Background: A good plan of management is extremely important for the personalized management of breast cancer. In locally advanced breast cancer, neoadjuvant chemotherapy has a vital role in good subsequent management. There are some predictors for the assessment of clinical and pathological response.

Aim of the Study: To observe the clinical and pathological factors as predictors for responsiveness of NACT in LABC patients.

Methods: It was a cross-sectional comparative study that was conducted among the patients of the Department of Surgical Oncology of NICRH from October 2016 to September 2017. Initially, all the patients were enrolled by purposive sampling. After that, they were scrutinized by eligibility criteria. One hundred patients were selected. A pre-formed, structured, peer-reviewed data collection sheet was prepared, which was used to collect data. Data were compiled, edited, managed and analyzed. The results were tabulated in table and figure form. Data analysis was done by chi-square test. The p-value was significant at <0.05.

Result: Out of the total, 42% and 28% belonged to the 41-50 years and 31-40 years age group respectively. The mean age was 44.51±10.77 years, and the age range was 22-73 years. Among 100 patients, 76% had a BMI between 18.5 and 24.99. Subsequently, 13% of patients had it between 25 and 29.99. The mean BMI of the respondents was 23.81±2.36. The BMI range was 17.83-31.13. 86% of patients were homemakers, 95% were married, and 92% had a history of breastfeeding. Out of 100 patients, 6% had a positive family history of breast cancer. Among 100 patients, 69% never took any form of hormonal contraceptive in their lifetime. Out of 100 patients, 87% patients were pre-menopausal, whereas the rest 13% were postmenopausal. Out of 100 patients, 80% presented with a lump, and the rest, 20% presented with lump and ulceration, and 54% had this lump on the left side. 75% of patients manifested regional disease, whereas 25% of patients manifested local disease out of 100 cases, 62% of patients suffered <4 months duration, and subsequently, 35% of patients experienced symptoms from 4-6 months. Only 3% noticed clinical features for more than 6 months. Out of 100 patients with LABC, there was no such a patient with a lump size <2cm, but 13% of patients responded well after NACT as they were found in this group. Initially, 5% of patients belonged to lump size 2-5cm, which was increased to 67% after NACT. On the other hand, 95% of patients had lumps>5cm in maximum diameter, which was reduced to 20% after NACT. The p-value was found to be significant. 76% of patients had pre-NACT palpable axillary lymph nodes, which dropped down to 65% after NACT intervention; on the contrary, 27% fixed axillary lymph nodes were reduced into 15% fixed axillary lymph nodes. Before NACT, 8% of patients had palpable ipsilateral supraclavicular lymph nodes, which reduced and became 4% after the implementation of NACT. Out of 100 LABC patients, 70% received an AC regimen, and 30% received an FEC regimen. Among 100 LABC patients, clinical response was observed at 77% as PR and 13% as CR. 8% and 2% of patients manifested PD and SD as clinical responses after NACT. Clinically palpable lymph nodes and chemotherapy showed significant predictors for clinical response (p=0.01 and 0.039 respectively), whereas age, clinical tumor size, lymphatic and vascular invasion, and molecular subtypes were the significant predictors for pathological response.

Conclusion: Most of our patients showed partial response. However, from the point of view of predictive markers of NACT, clinically palpable lymph nodes, as well as chemotherapy, are the influencing factors for good clinical response. In contrast, age, clinical tumor size, lymphatic and vascular invasion and molecular subtypes are excellent markers for pathological response.

Keywords: Assessment, Clinic Pathological, Predictive Markers, Neoadjuvant Chemotherapy, Locally Advanced Breast Cancer (LABC).