Highlights
- •Clinical utility of CPS + EG in triple-negative breast cancer (TNBC) was assessed.
- •1795 patients with TNBC from 8 prospective neoadjuvant trials were anaylsed.
- •CPS + EG does not add clinically useful information beyond the pathological stage.
- •Pathological complete response remains the single most clinically useful prognostic factor after neoadjuvant chemotherapy.
Abstract
Background
Pathological complete response (pCR) after neoadjuvant chemotherapy (NACT) is associated
with superior survival. This association is strongest in triple-negative breast cancer
(TNBC). The CPS + EG system, based on pre-treatment clinical (CS) and post-treatment pathological stage (PS), oestrogen-receptor status (E) and grade (G), leads to a refined estimate of prognosis after NACT in all-comers and hormone receptor–positive/human
epidermal growth factor receptor 2 (HER2)-negative breast cancer. Here, we investigate
if CPS + EG scoring provides a superior estimate of prognosis in TNBC to select patients
for postneoadjuvant therapy.
Methods
We calculated the CPS + EG score for 1795 patients with TNBC from 8 prospective German
trials. Five-year disease-free survival (DFS) and overall survival estimates were
calculated using the Kaplan-Meier method.
Results
In TNBC, patients with pCR (ypT0/is ypN0, n = 822, 45.8%) had a 5-year DFS of 86%,
whereas patients with residual American Joint Committee on Cancer stage I disease
(n = 383; 21.3%) had a 5-year DFS of 77.5%.CPS + EG led to superior prognostic information
compared with that provided by the clinical stage, but it was inferior to the prognostic
information provided by the pathological stage (c-index statistics, p < 0.001). CPS + EG
did not discriminate prognosis within the two best prognostic groups (score 1 and
2; n = 362; 37.2%). In contrast, pCR status added prognostic information beyond CPS + EG.
Patients with a CPS + EG score of 3 had a 5-year DFS rate of 64% overall, but those
with pCR had a 5-year DFS rate of 84%, and those without pCR had a 5-year DFS rate
of only 49.7%.
Conclusions
In TNBC, CPS + EG scoring provided inferior prognostic information compared with the
pathological stage and was unable to identify patients without pCR and with a sufficiently
good prognosis, who could avoid postneoadjuvant therapy. pCR remains the strongest
and most clinically useful prognostic factor after NACT. Other biologic factors beyond
pCR are needed in TNBC.
Keywords
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Article info
Publication history
Published online: June 26, 2021
Accepted:
May 20,
2021
Received in revised form:
May 17,
2021
Received:
January 18,
2021
Identification
Copyright
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