Annals of Oncology Advance Access originally published online on August 19, 2005
Annals of Oncology 2006 17(2):353-354; doi:10.1093/annonc/mdj009
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© 2005 European Society for Medical Oncology
letter to the editor |
Response to letter "Analysis of breast cancer survival by clinical response to neoadjuvant chemoendocrine therapy" by Bogaerts et al. (Ann Oncol 2006; 17: 352–353)
The data has been re-analysed for disease-free and overall survival by means of a multivariate Cox regression analysis. Adjustment has been made for age, T stage and N stage. At the time that this study was conducted, most breast cancer diagnoses were confirmed by fine needle sample alone, and not biopsy. Therefore, no pre-chemotherapy tissue was available for assessment of histopathological features, such as grade, which impact on disease outcome [1
]. Tissue taken at surgery after completion of chemotherapy was available for many patients but it is unclear whether this is an accurate reflection of pre-chemotherapy features [2]. After multivariate analysis adjusted for T and N stage, good response remains statistically significantly related to disease-free survival (P = 0.02) (Fig. 1) and overall survival (P = 0.02) (Fig. 2). This does not exclude a bias due to oestrogen receptor status or grade. Furthermore, the magnitude of the difference is considerable (77% versus 63% for overall survival).
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Although our study is very modest in size, unlike large multi-centre studies, it is strengthened by the fact that clinical response was assessed by a limited number of individuals. We agree that more data is needed to characterise further the relationship between response and outcome, particularly in view of the fact that the large EORTC 10902 failed to confirm this on multivariate analysis [3
]. We agree that a relationship between good clinical response and favourable outcome may reflect a more favourable natural history in tumours that demonstrate good response, rather than a treatment effect. This seems unlikely in view of the fact that high base-line Ki-67 is a predictor of good clinical response [4] but a poor prognostic factor overall [5].
Institute of Cancer Research, Fulham Road, London SW3 6JB, UK
* E-mail: s.cleator{at}imperial.ac.uk
References
1. Galea MH, Blamey RW, Elston CE, Ellis IO. The Nottingham Prognostic Index in primary breast cancer. Breast Cancer Res Treat 1992; 22: 207–219.[CrossRef][Web of Science][Medline]
2. Daidone MG, Silvestrini R, Luisi A et al. Changes in biological markers after primary chemotherapy for breast cancers. Int J Cancer 1995; 61: 301–305.[Medline]
3. van der Hage JA, van de Velde CJ, Julien JP et al. Preoperative chemotherapy in primary operable breast cancer: results from the European Organization for Research and Treatment of Cancer trial 10902. J Clin Oncol 2001; 19: 4224–4237.
4. Petit T, Wilt M, Velten M et al. Comparative value of tumour grade, hormonal receptors, Ki-67, HER-2 and topoisomerase II alpha status as predictive markers in breast cancer patients treated with neoadjuvant anthracycline-based chemotherapy. Eur J Cancer 2004; 40: 205–211.[CrossRef][Medline]
5. Brown RW, Allred CD, Clark GM et al. Prognostic value of Ki-67 compared to S-phase fraction in axillary node-negative breast cancer. Clin Cancer Res 1996; 2: 585–592.[Abstract]
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