Clinical and pathological factors predictive of response to neoadjuvant chemotherapy in Locally Advanced breast cancer


  • Aliyah Mohammad Salih Department of pathology,Omar Almukhtar university, Albieda, Libya.
  • Asma Aboubakr Abdalraziq Department of pathology,Omar Almukhtar university, Albieda, Libya.
  • Raba M. Abdalkarim Department of pathology,Omar Almukhtar university, Albieda, Libya.



locally advanced breast cancer, neoadjuvant chemotherapy NAC, pathologic complete response (pCR)


This study was performed to examine the predictive factors of pathologic complete response (pCR) in locally advanced breast cancer (LABC) patients after neoadjuvant chemotherapy (NAC). LABC remains a clinical challenge, as distant metastasis develops in most patients, and they will experience disease relapse and eventual death. The identification of reliable predictive factors for neoadjuvant chemotherapy in LABC would help select those patients most likely to benefit from neoadjuvant chemotherapy. 84 LABC Egyptian patients with neoadjuvant therapy regimens containing 3-6 cycles of anthracyclin-based chemotherapy, followed by modified radical mastectomy (MRM) and node dissections, followed by adjuvant hormonal therapy and Radiotherapy.The patients were divided into two groups: pathological complete response (pCR) or non-pCR group. Clinico-pathological characteristics were compared and analyzed, and multivariate analyses were performed to detect the predictive factors of pCR. The pCR rate in both the breast and axilla was (8.33%), and 91.67% of the patients showed partial response. Multivariate logistic regression demonstrated that pCR was significantly associated with The absence of nodal metastasis, necrosis, lymphovascular invasion and carcinoma in situ and negative ER , PR and HER2 and the non-triple negative tumours. the absence of tumor necrosis, DCIS and LVI and negative hormonal status on initial core biopsy are linked to achieving pCR


Barasha Sarma Bharadwaj, Neelakshi Mahanta, Bibhash Chandra Goswami, Kanakeshwar Bhuyan 2020. Response to neoadjuvant chemotherapy in locally advanced breast cancers in association with different clinicopathological parameters10.4103/oji.oji_26_20.

Bear HD, Anderson S, Brown A, Smith R, Mamounas EP, Fisher B, et al. 2003. The effect on tumor response of adding sequential preoperative docetaxel to preoperative doxorubicin and cyclophosphamide: preliminary results from National Surgical Adjuvant Breast and Bowel Project Protocol B-27. Journal of clinical oncology:. 21:4165–74.

Brifford M, Spyratos F, Tubiana-Hulin M, et al. 1989. Sequential cytopuncture during preoperative chemotherapy for primary breast carcinoma: cytomorphologic changes, initial tumor ploidy, and tumor regression. Cancer 63:631-37.

Carey LA, Dees EC, Sawyer L et al .2007. The triple negative paradox: Primary tumor chemosensitivity of breast cancer subtypes. Clin Cancer Res 13:2329–2334

Costa SD, Loibl S, Kaufmann M, Zahm DM, Hilfrich J, Huober J, et al2010. Neoadjuvant chemotherapy shows similar response in patients with inflammatory or locally advanced breast cancer when compared with operable breast cancer: a secondary analysis of the GeparTrio trial data. J Clin Oncol 28:83–91.

Del Prete S, Caraglia M, Luce A, Montella L, Galizia G

Sperlongano P, Cennamo G, Lieto E, Capasso E, Fiorentino O, Aliberti M, Auricchio A, Iodice P, Addeo R.2019. Clinical and pathological factors predictive of response to neoadjuvant chemotherapy in breast cancer: A single center experience. Oncol Lett. 18:3873-3879.

Díaz-Casas SE, Castilla-Tarra JA, Pena-Torres E, Orozco-Ospino M, Mendoza-Diaz S, Nuñez-Lemus M, et al.2019. Pathological response to neoadjuvant chemotherapy and the molecular classification of locally advanced breast cancer in a Latin American Cohort. Oncologist 24:e1360-70.

Edge SB, Compton CC.2010, The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM.Ann Surg

Estévez LG, Gradishar WJ.2004. Evidence-based use of neoadjuvant taxane in operable and inoperable breast cancer. Clin Cancer Res 10:3249-61

Fayanju OM, Ren Y, Thomas SM, Greenup RA, Plichta JK, Rosenberger LH, et al.2018. The clinical significance of breast-only and node-only pathologic complete response (pCR) after neoadjuvant chemotherapy (NACT): A review of 20,000 breast cancer patients in the National Cancer Data Base (NCDB). Ann Surg 268:591-601.

Fisher B, Brown A, Mamounas E, Wieand S, Robidoux A, Margolese RG, et al. 1997. Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-18. Journal of clinical oncology: official journal of the American Society of Clinical Oncology. 15:2483–93

Hammond ME, Hayes DF, Dowsett M. 2010. American Society of Clinical Oncology/College of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. J Clin Oncol; 28:2784–27

Hee Jin Lee , In Ah Park , In Hye Song , Sung-Bae Kim , Kyung Hae Jung , Jin-Hee Ahn , Sei-Hyun Ahn , Hak Hee Kim , Gyungyub Gong Comparison of Pathologic Response Evaluation Systems After Anthracycline With/Without Taxane-Based Neoadjuvant Chemotherapy

Among Different Subtypes of Breast Cancers Affiliations

expandPMID: 2639432.PMCID:

International Union Against Cancer (UICC). TNM Classification of Malignant Tumors, 6th ed. Sobin LH, Wittekind Ch., eds. New York: Wiley; 2002.

Jacquillat C, Weil M, Baillet F, et al.1990. Results of neoadju- vant chemotherapy and radiation therapy in the breast conserv- ing treatment of 2.50 patients with all stages of infiltrative breast cancer. Cancer 16:119-29.

Jang CE, Kim JR.2015. Prognostic factor in patient with locally advanced breast cancer treated with neoadjuvanttaxane – Anthracycline combination chemotherapy. Korean J Clin Oncol 11:106-13

Jinhua Ding, Yinlong Yang, Li Jiang, Weizhu Wu and Zhiming Shao 2017. Predictive factors of pathologic

complete response in HER2- positive and axillary lymph node positive breast cancer after neoadjuvant paclitaxel, carboplatin plus with trastuzumab. Oncotarget, 34: 56626-56634.

Kuerer Henry M., Lisa A. Newman, Terry L. Smith, Fred C. Ames, Kelly K. Hunt, Kapil Dhingra, Richard L. Theriault,Gurpreet Singh, Susan M. Binkley, Nour Sneige, Thomas A. Buchholz, Merrick I. Ross, Marsha D. McNeese,Aman U. Buzdar, Gabriel N. Hortobagyi, and S. Eva Singletary1999 Clinical Course of Breast Cancer Patients With Complete Pathologic Primary Tumor and

Axillary Lymph NodeResponse to Doxorubicin-Based Neoadjuvant Chemotherapy Journal of Clinical Oncology 17:460-9.

Liedtke C, Mazouni C, Hess KR et al . 2008. Response

to neoadjuvant therapy and long-term survival in patients with triple-negative breast cancer. J Clin Oncol 26:1275–1281.

Loibl S, von Minckwitz G, Untch M, Denkert C. 2014 .

Predictive factors for response to neoadjuvant therapy in breast cancer. Oncol Res Treat. ;37:563-8.

Masters JRW, Camplejohn RS, Millis RR, Rubens RD. 1987. Histologic grade, elastosis, DNA ploidy, and the response to chemotherapy. BY 1 Cancer;55:455-57.

Mauriac L, Durant M, Auril A, et al.1991. Effect of primary Pathologic Predictors of Tumor Response 101

chemotherapy in conservative treatment of breast cancer

patients with operable tumors larger than 3 cm. Ann Oncol 2: 347-54.

O'Reilly SM, Camplejohn RS, Richards MA.1992. DNA flow cytometry and response to preoperative chemotherapy for pri- mary breast cancer. Etrr J Cancer 28:681-83.

Patel T, Gupta A, Shah M.2013. Pathological predictive factors for tumor response in locally advanced breast carcinomas treated with anthracyclin-based neoadjuvant chemotherapy. J Cancer Res Ther;9:245-9

Penault-Llorca F, Abrial C, Raoelfils I. 2008. Comparison of the prognostic significance of Chevallier and Sataloff’s pathologic classifications after neoadjuvant chemotherapy of operable breast cancer. Hum Pathol. 39:1221–1228.

Remvikos Y, Jouve M, Beuzeboc P, Viehl P, Magdelenat H, Pouillort R.1993. Cell cycle modifications of breast cancers during neoadjuvant chemotherapy: a flow cytometry study on fine needle aspirates. Eur Cancer 13:1843-48.

Rubovszky G, Horváth ZJ 2017. Recent Advances in the Neoadjuvant Treatment of Breast Cancer. Breast Cancer. 2:119-131.

Rustogi A, Budrukkar A, Dinshaw K, Jalali R. 2005. Management of locally advanced breast cancer: evolution and current practice. J Cancer Res Ther 1:21–30.

Saxena S, Rekhi B, Bansal A, Bagga A, Chintamani , Murthy NS .2005. Clinico-morphological patterns of breast cancer including family history in a New Delhi hospital, India – A cross-sectional study. World J Surg Oncol 3:6730. Silvestrini R, Diadone MG, Valagussa P, Salvadori B, Rovini D, Bonadonna G.1991. Cell kinetics as a prognostic marker in locally advanced breast cancer. Eur J Surg Oncol 17:603-7.

Thompson AM, Moulder-Thompson SL 2012. Neoadjuvant treatment of breast cancer. Ann Oncol. Suppl 10:x231-6.

Untch M, Konecny GE, Paepke S, von Minckwitz G. 2014.The current and future role of neoadjuvant therapy for breast cancer. Breast. 23(5):526-37.




How to Cite

Aliyah Mohammad Salih, Asma Aboubakr Abdalraziq, & Raba M. Abdalkarim. (2023). Clinical and pathological factors predictive of response to neoadjuvant chemotherapy in Locally Advanced breast cancer. Sirte Journal of Medical Sciences, 2(1), 12–18.