Locoregional risk assessment after neoadjuvant chemotherapy in patients with primary breast cancer: clinical utility of the CPS+EG score

Purpose:

Locoregional control is an important goal in breast cancer therapy but the prediction of locoregional recurrence to guide local therapy after neoadjuvant chemotherapy remains a challenge. The CPS+EG score was designed to predict distant recurrence. Here we examine its ability to predict both – distant and locoregional recurrence.

Methods:

Clinical data from 432 patients treated with neoadjuvant chemotherapy between 2003 and 2011 was prospectively collected. We analyzed the probabilities of local and distant recurrences according to individual prognosis scores, stratified by type of surgery using the Kaplan-Meier method. Possible confounding of the relationship between recurrence risk and CPS+EG score by established risk factors was accounted for in multiple survival regression models. We analyzed the performance of the CPS+EG score to predict isolated locoregional recurrence by censoring patients with simultaneous distant metastases.

Results:

5-year locoregional-recurrence-free-survival was 90%, 5-year distant metastases-free-survival was 82%. The CPS+EG score stratified patients into six prognostic groups with distinct 5-year locoregional-recurrence-free-survival, ranging from 100% to 41% (p = 0.02) and 5-year distant metastases-free-survival, ranging from 96% to 35% (p < 0.0001). 8 patients with CPS+EG scores ≥4 experienced locoregional recurrence – 5 of them presented with simultaneous distant disease.

Conclusions:

The CPS+EG score, which was designed to predict distant disease, is also valuable for assessing local recurrence risks. Our data demonstrate that distant and locoregional recurrence risks are closely linked. As prognosis of patients at high risk for locoregional recurrence is determined by their risk for distant disease, escalating local therapy will have limited impact on overall prognosis.