Prognostic factors of locally advanced breast cancer patients receiving neoadjuvant and adjuvant chemotherapy.

BACKGROUND Neoadjuvant chemotherapy is known to be beneficial for down-staging patients with locally advanced breast cancer. Clinical stage, degree of cell differentiation and expression of estrogen/progesterone receptors and HER2/neu are all prognostic factors that may effect survival of patients with locally advanced breast cancer. The present study was conducted to determine their influence in a series of Indonesian patients. MATERIALS AND METHODS The subjects were a total of 52 patients with locally advanced breast cancer in Sardjito General Hospital Yogyakarta, from January 2003 to June 2006. Survival analysis with Kaplan Meier was tested for age, clinical stage, degree of histological differentiation, estrogen-progesterone receptor (ER/PR), HER-2 expression and neoadjuvant as well as adjuvant chemotherapy. To find the most important influencing factors, significant variables were tested with multivariate Cox regression. RESULT Of the 52 patients with locally advanced breast cancer, most were between 40-60 years old (41, 78%), almost half were stage IIIA (23, 44%), and the majority were negative for ER and PR (32, 61%). Her2 positivity was found in 29 patients (55%) and a moderate histological grade in 26 (50%). Thirty-nine patients were alive at the end of the study period (75%). There were no significant differences in survival between patients with and without adjuvant and neoadjuvant chemotherapy. Tumor characteristics that did influence survival were advanced stage (p<0.001) and histological grade (p<0.001), while HER-2 and ER/PR hormonal status had no effect. CONCLUSION Clinical stage and degree of histological grade are the most significant prognostic factors for Indonesian locally advanced breast cancer cases, while hormonal status and HER-2 did not appear impact on our patient's survival.