Outcome in locally advanced breast cancer can be predicted by baseline tumor markers and post-chemotherapy nodal status

Locally advanced breast cancer (LABC) still represents a common oncologic problem. Despite the improvement in outcome following the introduction of multimodality therapeutic strategies, the prognosis of LABC remains generally poor. The aim of the present retrospective analysis was to better define prognostic subgroups within this still heterogeneous entity. METHODS: Between 1990 and 1999, 104 consecutive patients (pts) with LABC were treated at the RMC by a multimodality program. After 4-6 courses of CAP (Cyclophosphamide 600mg/m2, Doxorubicin 60mg/m2, 5fluorouracil 600mg/m2, q 21 days) induction chemotherapy, patients underwent surgery, breast-conserving when feasible. In most cases, chemotherapy was then resumed, to a total of 8 courses, followed by locoregional radiation therapy. Pts with hormonal receptor positive tumors received Tamoxifen (20mg/day) for 5 years. RESULTS: At a median follow-up of 57 months, the 5-year overall survival (OS) for the entire group and the disease free survival for 94 operated pts (DFS) were 65% and 53%, respectively. Univariate analysis identified four pretreatment prognostic factors, in terms of both OS and DFS: inflammatory features, clinical size of primary tumor, grade, and baseline tumor markers (CEA and CA-15.3). We also identified multiple treatment-related prognostic factors: the type of both clinical (predicting DFS only) and pathological reponse to induction chemotherapy, the type of surgery, the size of the residual tumor, the number of the residual involved nodes and extracapsular spread. By multivariate analysis, four factors retained statistical significance: inflammatory breast cancer (IBC) (p=0.000 for OS; p=0.015 for DFS) and baseline tumor markers (p=0.003 for both OS and DFS), as well as the post-chemotherapy number of involved nodes (p=0.002 for OS; p=0.017 for DFS) and extracapsular spread (p=0.052 for OS; p=0.014 for DFS), as assessed postoperatively. CONCLUSION: Together with the well recognized impact of IBC, baseline tumor markers and post-chemotherapy nodal status seem to strongly predict the outcome of pts with LABC.