Predictive Factors Involved in Determining Response to Neoadjuvant Chemotherapy in Breast Cancer and Impact of Response on 5 Years Disease Free Survival and Overall Survival

Objective: To evaluate all the known factors that may play a role in predicting response to Neoadjuvant chemotherapy in breast cancer and to see impact of response on five years’ disease free survival (DFS) and Overallsurvival (OS). Material and Method: Data of 156 patients was reviewed retrospectively from January 2012 to December 2012 at Shaukat Khanum Memorial Cancer Hospital and Research Centre Lahore, Pakistan. All received neoadjuvant chemotherapy (NAC) and had no distant metastasis. The response was measured in term of percentage reduction from 1st radiological size on presentation to final size on histopathology (of resected specimen). Four groups were identified, complete responder (CR) (100% reduction), Responders (R) (>50% reduction), Partial responder (PR) (<50% reduction) and Non-responder (NR). Relationship of predictive factors with each response group was observed. Five year survival was noted for each response group. Result: Median age of patients was 45 years (25-64 years). 67% of patients underwent breast conservation surgery, while the rest underwent mastectomy. Mortality for whole group was 22%, and recurrence was shown in 34% (Majority i.e. 26% were distant, while contralateral were 3%). Out of 156 patients, 25% of patients were CR, 13% were NR, 23% were PR and 37% were R. Progesterone receptor negative and Grade III tumors showed more complete responses. The Rest of the receptor types, including triple negative, initial T and N stage and other clinical factors showed no impact on chemo-response. Survival was significantly poor in NR group (45% OS, 40% DFS), while rest of three groups had comparable survival outcome, with CR group having best survival outcome (86% OS, 80% DFS). Conclusion: Most of factors studied did not show impact on achieving good chemo response, however good chemo response did show better survival.