J Breast Cancer.  2019 Dec;22(4):497-521. 10.4048/jbc.2019.22.e49.

Predictive and Prognostic Roles of Pathological Indicators for Patients with Breast Cancer on Neoadjuvant Chemotherapy

• Li X
• Wang M
• Wang M
• Yu X
• Guo J
• Sun T
• Yao L
• Zhang Q
• Xu Y

• KMID: 2470889
• DOI: http://doi.org/10.4048/jbc.2019.22.e49

Abstract

Currently, neoadjuvant chemotherapy is a standard therapeutic strategy for breast cancer, as it can provide timely and individualized chemo-sensitivity information and is beneficial for custom-designing subsequent treatment strategies. To accurately select candidates for neoadjuvant chemotherapy, the association between various immunohistochemical biomarkers of primary disease and tumor response to neoadjuvant chemotherapy has been investigated, and results have shown that certain pathological indicators evaluated after neoadjuvant chemotherapy are associated with long-term prognosis. The Food and Drug Administration (FDA) has recommended that complete pathological response can be used as a surrogate endpoint for neoadjuvant chemotherapy, which is related to better prognosis. Considering that residual tumor persists in the majority of patients after neoadjuvant chemotherapy, the value of various pathological indicators of residual disease in predicting the long-term outcomes is being extensively investigated. This review summarizes and compares various predictive and prognostic indicators for patients who have received neoadjuvant chemotherapy, and analyzes their efficacy in different breast cancer subtypes.

Keyword

Biomarkers; Breast neoplasms; Neoadjuvant therapy; Pathology; Survival

MeSH Terms

Biomarkers
Breast Neoplasms*
Breast*
Drug Therapy*
Humans
Neoadjuvant Therapy
Neoplasm, Residual
Pathology
Prognosis
United States Food and Drug Administration
Biomarkers

Figure

• 

  Figure 1 The general clinical evaluating process of BC patients before and after NACT. Some evaluating results might provide additional prognostic information for patients received NACT (TILs and PD-L1 examination have not been routinely used in current clinical practice). BC = breast cancer; NACT = neoadjuvant chemotherapy; TILs = tumor-infiltrating lymphocytes; PD-L1 = programmed death ligand 1; MRI = magnetic resonance imaging; BI-RADS = Breast Imaging, Reporting and Data System; LVI = lymphovascular invasion; DCIS = ductal carcinoma in situ; IHC = immunohistochemistry; FISH = fluorescence in situ hybridization; RECIST = Response Evaluation Criteria in Solid Tumors; SLNB = sentinel lymph node biopsy; LN = lymph node; pCR = pathological complete response; RCB = residual cancer burden; TNM = tumor-node-metastasis; ER = estrogen receptor; PR = progesterone receptor; HER2 = human epidermal growth factor receptor 2; LNR = lymph node ratio.

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