The height, weight and laboratory data of the patients at admission are shown in Table 1. The mean age of the included 52 patients at diagnosis was 46 ± 9 (range: 26-67).
Table 1
Age, height, weight and laboratory data of the subjects at admission.
| Minimum | Maximum | Mean | Std. Deviation |
Age | 26.0 | 67.0 | 46.0 | 9.4 |
Height in cm | 145.0 | 175.0 | 160.0 | 7.0 |
Weight in Kg | 42.0 | 116.0 | 68.0 | 14.0 |
ALT | 7.0 | 75.0 | 19.0 | 13.0 |
AST | 8.0 | 45.0 | 18.0 | 7.8 |
Albumin | 4.0 | 5.2 | 4.5 | 0.3 |
Total Biluribin | 0.1 | 1.0 | 0.4 | 0.2 |
Creatinine | 0.5 | 0.9 | 0.7 | 0.1 |
GFR | 76.0 | 124.0 | 102.0 | 13.4 |
Calcium | 8.8 | 10.6 | 9.6 | 0.4 |
CRP | 0.1 | 4.8 | 0.8 | 1.1 |
CEA | 0.6 | 26.0 | 4.1 | 4.7 |
CA 15-3 | 1.2 | 74.7 | 26.1 | 16.7 |
Hemoglobin | 9.8 | 15.1 | 12.8 | 1.3 |
Platelet | 206000.0 | 442000.0 | 300038.0 | 60741.0 |
Neutrophil | 1960.0 | 7560.0 | 4340.0 | 1411.0 |
Lymphocyte | 620.0 | 7310.0 | 2214.0 | 1099.0 |
MPV | 7.5 | 11.7 | 9.9 | 0.9 |
NLR | 0.6 | 6.1 | 2.3 | 1.1 |
PLR | 33.8 | 440.3 | 164.1 | 83.7 |
Table 2 shows the patient distribution according to chronic illness, Eastern Cooperative Oncology Group (ECOG) performance status, tumor multifocality, tumor category (T), lymph node involvement, tumor stage, surgical method, histological grade, side efect of cardiotoxicity.
Table 2
Patient distribution according to chronic illness, ECOG, side effect of cardiotoxicity and tumor related factors.
| Count | Percent |
Chronic illness |
Present | 20 | 38.50% |
Absent | 32 | 61.50% |
ECOG |
0 | 42 | 80.80% |
1 | 9 | 17.30% |
2 | 1 | 1.90% |
Stage at diagnosis |
1 | 1 | 1.90% |
2 | 7 | 13.50% |
3 | 44 | 84.60% |
Localisation of tumor |
Right | 24 | 46.20% |
Left | 24 | 46.20% |
Bilateral | 4 | 7.0% |
T category |
T1 | 10 | 19.20% |
T2 | 27 | 51.90% |
T3 | 12 | 23.10% |
T4 | 3 | 5.80% |
Lymph node status |
N0 | 0 | 0% |
N1 | 19 | 36.50% |
N2 | 24 | 46.20% |
N3 | 9 | 17.30% |
Histological grade |
gr1 | 0 | 0% |
gr2 | 23 | 44.20% |
gr3 | 29 | 55.80% |
Multifocality |
Present | 25 | 48.10% |
Absent | 27 | 51.90% |
Type of surgery |
Partial mastectomy | 33 | 63.50% |
Total mastectomy | 19 | 36.50% |
Cardiotoxicity |
Present | 3 | 5.80% |
Absent | 49 | 94.20% |
While 80.8% (42) of the patients received anthracyclines, 19.2% (10) had chemotherapy regimens containing platinum. 50% of the patients (26) were premenopausal in diagnosis, 84.6% (44) had stage 3 tumor, 15.4% (8) had stage 1 or 2 tumor. 32.7% (17) of the patients were negative for hormone receptors. In 80.8% (42) of the patients, Ki67 was over 20%.
Table 3 shows pathological response status in relation to chemotheraphy regimen, Ki67 level, patient age, menopausal status, lymph node status,hormon receptor status and stage of tumor.
Table 3
Pathological response status in relation to several variables.
| Count (% in column) | Pathological response | P |
Presence of Residuals(% in row) | pCR (%in row) |
Chemotheraphy regimen | | | | 1.000 |
Antracycline | 42(80.80%) | 12(28.6%) | 30(71.4%) |
Platine | 10(19.20%) | 3(30%) | 7(70%) |
Ki67 | | 0.447 |
≤%20 | 10(19.20%) | 4(40%) | 6(60%) | |
>%20 | 42(80.80%) | 11(26.2%) | 31(73.8%) | |
Age | | | | 0.021 |
<40 | 16(30.80%) | 1(6.2%) | 15(93.8%) |
≥40 | 36(69.20%) | 14(38.9%) | 22(61.1%) |
Menopause | | | | 0.054 |
Present | 26(50.00%) | 9(34.6%) | 17(65.4%) |
Absent | 26(50.00%) | 6(23.1%) | 20(76.9%) |
Lymph node status | | | | 0.004 |
N1 | 19(36.50%) | 1(5.3%) | 18(94.7%) |
N2-3 | 33(63.50%) | 14(42.4%) | 19(57.6%) |
Category T | | | | 0.339 |
T1 | 10(19.2%) | 4(40%) | 6(60%) |
T2 | 27(51.9%) | 9(33.3%) | 18(66.7%) |
T3 | 12(23.1%) | 1(8.3%) | 11(91.7%) |
T4 | 3(5.8%) | 1(33.3%) | 2(66.7%) |
Hormone receptor status | | | | 0.525 |
ER or PR + | 35(67.30%) | 9(25.7%) | 26(74.3%) |
ER and PR - | 17(32.70%) | 6(35.3%) | 11(64.7%) |
Stage at diagnosis | | | | 0.412 |
1-2 | 8(15.40%) | 1(12.5%) | 7(87.5%) |
3 | 44(84.60%) | 14(31.8%) | 30(68.2%) |
Total | 52(100%) | 15(28.8%) | 37(71.2%) | |
The overall pCR rate was 71.2% (37) and pCR was 71.4% (30) in the group that used anthracycline containing regimen and 70% (7) in the group that used TCHP regimen(p=1.000). In patients with breast cancer who received dual HER-2 blockades, it was found that using a regimen containing anthracycline in addition to neoadjuvant therapy did not affect pCR.
pCR in premenopausal patients was 76.9% (20), while the pCR in postmenopausal patients was 65.4% (17), menopausal status was found not to affect pCR (p:0.54). In premenopausal or postmenopausal patients, taking a regimen containing anthracyclines did not contribute to pCR(p>0.050).
pCR was significantly higher in those under 40 years of age (93.8% vs 61.1%, p=0.02). 87.5% of patients under 40 had a regimen containing anthracycline, compared to 77.8% in the over-40s. (p:0.705).
According to the TNM classification, the pCR was 94.7% in those with clinically N1 and 57.6% in those with N2-3 (p:0.004)(Table 3) 68.4% of N1 people received an anthracycline containing regimen, while 87.9% of N2-3 ones received regimen containing anthracycline(p=0.142).
In the group with a Ki67 index below 20%, the pCR was 60%, while in the group above 20%, the pCR was 73.8%(p=0.447).
In the group with negative hormone receptors, pCR was 64.7%, while pCR was 74.3% in the group with positive hormone receptor. The difference was not statistically significant. (p:0.525)
pCR was 68.2% in those with stage 3 disease at the time of diagnosis, while pCR was 87.5% in those with stage 1-2 disease. The difference was not statistically significant (p=0.412). In those with stage 3 disease, regimens containing anthracycline were 81.8% and in those with stage 1-2 it was 75% (p=0.642).
While the rate of patients with cardiotoxicity with dual blockade was 5.8% (3), all these 3 patients were under 65 years of age and used anthracycline containing regimen as well as dual HER-2 blokage as adjuvant. HER-2 blockade was terminated in these patients as soon as the detection of cardiotoxicity.