Utility of the CPS + EG scoring system in triple-negative breast cancer treated with neoadjuvant chemotherapy

Marmé F, Solbach C, Michel L, Schneeweiss A, Blohmer JU, Huober J, Fasching P, Jackisch C, Nekljudova V, Link T, Rhiem K, Rey J, Denkert C, Hanusch C, Tesch H, Lederer B, Loibl S, Untch M (2021)

Publication Type: Journal article

Publication year: 2021

Journal

European Journal of Cancer Elsevier

Book Volume: 153

Pages Range: 203-212

DOI: 10.1016/j.ejca.2021.05.027

Abstract

Background: Pathological complete response (pCR) after neoadjuvant chemotherapy (NACT) is associated with superior survival. This association is strongest in triple-negative breast cancer (TNBC). The CPS + EG system, based on pre-treatment clinical (CS) and post-treatment pathological stage (PS), oestrogen-receptor status (E) and grade (G), leads to a refined estimate of prognosis after NACT in all-comers and hormone receptor–positive/human epidermal growth factor receptor 2 (HER2)-negative breast cancer. Here, we investigate if CPS + EG scoring provides a superior estimate of prognosis in TNBC to select patients for postneoadjuvant therapy. Methods: We calculated the CPS + EG score for 1795 patients with TNBC from 8 prospective German trials. Five-year disease-free survival (DFS) and overall survival estimates were calculated using the Kaplan-Meier method. Results: In TNBC, patients with pCR (ypT0/is ypN0, n = 822, 45.8%) had a 5-year DFS of 86%, whereas patients with residual American Joint Committee on Cancer stage I disease (n = 383; 21.3%) had a 5-year DFS of 77.5%.CPS + EG led to superior prognostic information compared with that provided by the clinical stage, but it was inferior to the prognostic information provided by the pathological stage (c-index statistics, p < 0.001). CPS + EG did not discriminate prognosis within the two best prognostic groups (score 1 and 2; n = 362; 37.2%). In contrast, pCR status added prognostic information beyond CPS + EG. Patients with a CPS + EG score of 3 had a 5-year DFS rate of 64% overall, but those with pCR had a 5-year DFS rate of 84%, and those without pCR had a 5-year DFS rate of only 49.7%. Conclusions: In TNBC, CPS + EG scoring provided inferior prognostic information compared with the pathological stage and was unable to identify patients without pCR and with a sufficiently good prognosis, who could avoid postneoadjuvant therapy. pCR remains the strongest and most clinically useful prognostic factor after NACT. Other biologic factors beyond pCR are needed in TNBC.

Authors with CRIS profile

Peter Fasching Professur für Translationale Frauenheilkunde und Geburtshilfe

Involved external institutions

Universitätsklinikum Carl Gustav Carus Dresden DE Germany (DE) Universitätsklinikum Ulm DE Germany (DE) Charité - Universitätsmedizin Berlin DE Germany (DE) Deutsches Krebsforschungszentrum (DKFZ) DE Germany (DE) Universitätsklinikum Gießen und Marburg (UKGM) DE Germany (DE) Sana Kliniken AG DE Germany (DE) Centrum für Hämatologie und Onkologie Bethanien DE Germany (DE) Universitätsklinikum Frankfurt am Main (KGU) DE Germany (DE) GBG Forschungs GmbH (German Breast Group) DE Germany (DE) HELIOS Kliniken DE Germany (DE) Universitätsklinikum Heidelberg DE Germany (DE) Rotkreuzklinikum München DE Germany (DE) Universitätsklinikum Köln DE Germany (DE)

How to cite

APA:

Marmé, F., Solbach, C., Michel, L., Schneeweiss, A., Blohmer, J.U., Huober, J.,... Untch, M. (2021). Utility of the CPS + EG scoring system in triple-negative breast cancer treated with neoadjuvant chemotherapy. European Journal of Cancer, 153, 203-212. https://doi.org/10.1016/j.ejca.2021.05.027

MLA:

Marmé, Frederik, et al. "Utility of the CPS + EG scoring system in triple-negative breast cancer treated with neoadjuvant chemotherapy." European Journal of Cancer 153 (2021): 203-212.

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