Document Type : Original Article
Authors
1
-Laboratory of Nutrition, Pathology, Agro Biotechnology and Health, Djillali Liabes University, Sidi Bel-Abbes, Algeria. - Department of Pharmacy, Faculty of Medicine, Djillali Liabes University, Sidi Bel-Abbes, Algeria.
2
Laboratory of Nutrition, Pathology, Agro Biotechnology and Health, Djillali Liabes University, Sidi Bel-Abbes, Algeria.-Department of Biology, Faculty of nature and life sciences, Djillali Liabes University, Sidi Bel-Abbes, Algeria.
3
Department of Pharmacy, Faculty of Medicine, Djillali Liabes University, Sidi Bel-Abbes, Algeria.
4
Department of Biology, Faculty of nature and life sciences, Djillali Liabes University, Sidi Bel-Abbes, Algeria.
5
Laboratory of Nutrition, Pathology, Agro Biotechnology and Health, Djillali Liabes University, Sidi Bel-Abbes, Algeria.-Department of Medicine, Faculty of Medicine, Djillali Liabes University, Sidi Bel-Abbes, Algeria.
Abstract
Prognostic factors are a clinical decision-making tool in choosing the most appropriate treatment for each patient. Women with operable breast cancer who have been treated with and without neoadjuvant chemotherapy (NCT) have significantly different outcomes. Finding a distinction between the outcomes of these two therapeutic situations is important because fractions of this population might benefit from other new adjuvant treatments.
The aim of this retrospective study was to identify certain prognostic factors by comparing the outcomes of patients that were treated with NCT (NCT subgroup) and without NCT (Non-NCT subgroup) in 470 women with operable breast cancer. Moreover, we attempted to elucidate the possible association between overall survival (OS) and disease-free survival (DFS) as a function of prognostic factors. Patients had a median age of 49 years (range 28-97). The clinical and pathological aspects compared between the two subgroups with and without NCT gave a highly significant difference (p <0.008). Indeed, patients of NCT subgroup had significantly fewer invaded lymph nodes (2.40 ± 0.32 vs 3.82 ± 0.25, p = 0.0003) and their positive lymph node status was lower than patients of Non-NCT subgroup (58.3% vs 71.3%, p = 0.003). Comparison of the two subgroups of patients (NCT versus Non-NCT) gives a significant difference in the positive Ki67 expression status where NCT subgroup has a low rate of positive Ki67 status compared to Non-NCT subgroup (60.7% vs 84%, p = 0.002). After a median follow-up of 32 months (range 5-138 months), the univaried analysis in the NCT subgroup showed that hormone receptors (HR) were a significant prognostic factor of 5-year OS and 5-year DFS with a respective p-value equal to 0.03 and 0.005. Patients with HR+ had a median OS of 72 months [95% CI: 63.50 -80.50]. The Her2 factor had a significant effect only on OS (p=0.035). Node invasion was strongly associated with survival (OS and DFS) (p <0.01).We found that Post-treatment assessments of the HR, lymph node involvement and Her2 status may have a promising role in predicting the outcome and must be strongly considered after neoadjuvant chemotherapy, in order to choose an adjuvant treatment for each individual patient.
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