Clinical and pathological response in “aggressive” immunohistochemical types of breast cancer: impact on the choice of oncoplastic or reconstructive surgery tactics, and the role of tumor biological characteristics

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Abstract

Background: Breast cancer is characterized by pronounced molecular heterogeneity, which determines differences in prognosis, sensitivity to therapy, and the potential for breast-preserving and reconstructive interventions. The most aggressive course is observed in triple-negative and Her2/neu-positive breast cancer types, which justifies the need for a comprehensive assessment of factors influencing the effectiveness of neoadjuvant treatment and the choice of surgical approach.

Objective: Evaluation of the impact of immunohistochemical (IHC) subtype and neoadjuvant drug treatment regimens on clinical and pathological response, as well as their relationship with the choice of surgical intervention in patients with prognostically unfavorable forms of breast cancer (BC).

Materials and methods: A retrospective study of 500 patients with stage II–III breast cancer was conducted. IHC types, neoadjuvant therapy regimens, clinical response, residual cancer burden (RCB), and the nature of surgical treatment were analyzed. Nonparametric statistical methods and categorical data analysis were used.

Results: Statistically significant differences were found between the subtypes in terms of Ki-67 levels, differentiation grade, and disease stage (p< 0.05). The rate of complete pathological response (RCB-0) was highest in the Her2/neu-positive subtype (70.2%) and lower in the triple-negative and luminal B, Her2/neu-positive subtypes (46.9 and 46.5%, respectively). Clinical response did not differ between the groups (p=0.312). The type of surgical intervention did not achieve statistically significant differences between the groups (p=0.066), but a tendency towards differences was noted. Differences were also found in the choice of specific oncoplastic and reconstructive techniques (p=0.021).

Conclusion: IHC subtype is a significant predictor of pathological response, but does not independently influence the choice of the extent of surgical intervention, which is determined primarily by clinical and anatomical factors. The obtained data substantiate the need to consider RCB when assessing therapy efficacy and planning treatment.

About the authors

M. V. Ermoschenkova

Oncology Center No. 1, S.S. Yudin City Clinical Hospital; I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: maryerm@mail.ru
ORCID iD: 0000-0002-4178-9592

Dr. Sci. (Med.), Head of the 1st Oncology Department (Oncomammology and Reconstructive Plastic Surgery), Professor, Department of Oncology, Radiotherapy, and Reconstructive Surgery, N.V. Sklifosovsky Institute of Clinical Medicine

Russian Federation, Moscow; Moscow

Maria P. Mglinets

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: m.mglinets@inbox.ru
ORCID iD: 0009-0001-1114-2296

Postgraduate Student, Department of Oncology, Radiotherapy, and Reconstructive Surgery, N.V. Sklifosovsky Institute of Clinical Medicine

Russian Federation, Moscow

V. N. Galkin

Oncology Center No. 1, S.S. Yudin City Clinical Hospital; I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: vsgalkin@gmail.com
ORCID iD: 0000-0002-6619-6179

Dr. Sci. (Med.), Chief Physician, Professor, Department of Oncology, Radiotherapy, and Reconstructive Surgery, N N.V. Sklifosovsky Institute of Clinical Medicine

Russian Federation, Moscow; Moscow

I. V. Reshetov

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: reshetoviv@mail.ru
ORCID iD: 0000-0002-0909-6278

Dr. Sci. (Med.), Professor, Academician of the Russian Academy of Sciences, Head of the Department of Oncology, Radiotherapy, and Plastic Surgery, N.V. Sklifosovsky Institute of Clinical Medicine, Director of the L.L. Levshin Institute

Russian Federation, Moscow

E. S. Kuzmina

Oncology Center No. 1, S.S. Yudin City Clinical Hospital

Email: KuzminaES1@zdrav.mos.ru
ORCID iD: 0009-0007-2856-5176

Cand. Sci. (Med.), Head of Chemotherapy Department No. 2, Day Hospital for Antitumor Drug Therapy No. 2

Russian Federation, Moscow

S. A. Arkova

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: sophaarkova@gmail.com
ORCID iD: 0000-0002-1843-8743

4th-year student, N.V. Sklifosovsky Institute of Clinical Medicine

Russian Federation, Moscow

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