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Background: For patients (pts) with HER2 positive (HER2+) breast cancer, the achievement of pathological complete response (pCR) after neoadjuvant chemotherapy is regarded as a surrogate endpoint of prognosis, however, the exact definition of pCR and its prognostic impact on survival in HER2+ breast cancer subtypes when stratified by hormonal receptor (HR) status is uncertain. Methods: We retrospectively investigated 163 HER2+ pts who received neoadjuvant chemotherapy in Hyogo Cancer Center between 2003 and 2010. HR+ was defined as estrogen or progesterone receptor positive. pCR at surgery was defined as no evidence of invasive and noninvasive residual in the breast or axillary nodes (ypT0 ypN0), no evidence of invasive residual in the breast or axillary nodes; noninvasive breast residuals allowed (ypT0/is ypN0), or no evidence of invasive residual in the breast; noninvasive breast residuals and infiltrated lymph nodes allowed (ypT0/is ypN0/+). Logistic regression analysis and logrank test were performed to identify HR status as a predictor of pCR and its prognostic significance on recurrence-free survival (RFS). Results: The median age at diagnosis was 55 years (range, 25-84) and the median follow- up period was 61 months (range, 15-104). Stage I, IIA, IIB, III were 4, 57, 56, 46 pts, HER2+HR+ and HER2+HR- were 89 and 74 pts, respectively. The rates of pts receiving anthracycline, taxane and trastuzumab were 66, 82 and 51%, respectively. After surgery, 98% of HER2+HR+ pts received hormonal therapy. Five-year RFS rates were significantly higher in HER2+HR- pts with pCR compared to non-pCR, however, which were similar in HER2+HR+ pts with pCR compared to non-pCR regardless of the pCR definitions. In logistic regression analysis, significantly fewer HER2+HR+ pts achieved pCR compared to HER2+HR- pts regardless of the pCR definitions. Conclusions: HER2+HR+ breast cancer pts had lower achievement rate of pCR, which was less prognostic compared to that in HER2+HR- pts regardless of pCR definitions. pCR is a suitable surrogate end point for HER2+HR- pts but not for HER2+HR+ pts in clinical trial settings. [ABSTRACT FROM AUTHOR]

Background: Many recent clinical trials conducted in Western populations suggest that obesity is a prognostic factor after primary treatment in postmenopausal breast cancer patients. However, the incidence of obesity differs substantially between Asian and Western breast cancer patients. Moreover, few studies have reported the relationship between body mass index (BMI) and postsurgical prognosis in Asian breast cancer patients. A previous retrospective analysis of Japanese populations revealed that obesity might be a prognostic risk factor in Japanese breast cancer patients. Methods: We retrospectively analyzed BMI and clinical outcomes after primary treatment in Japanese breast cancer patients of Hanshin and Hokkaido areas. We reviewed the clinical data (height, weight, BMI, estrogen receptor [ER] status, progesterone receptor status [PgR], human epidermal growth factor receptor 2 [HER2] status, and outcome) of 1,222 primary breast cancer patients with clinical stage I-III disease who were operated on between Jan 2004 and Dec 2005 at Kobe Breast Cancer Oncology Group (KBCOG) and Hokkaido Cancer Center (median follow-up period, 74 months). The patients were categorized into 4 groups: underweight (BMI, <18.5 kg/m²), normal (18.5-24.9 kg/m²), overweight (25-29.9 kg/m²), and obesity (>30.0 kg/m²). Patient characteristics, excluding age and menopausal status, were well-balanced across groups. The correlations of BMI with disease-free survival (DFS) and overall survival (OS) were analyzed using the Cox hazards model. Results: The normal, underweight, overweight, and obesity groups contained 832 (68.1%), 92 (7.5%), 253 (20.7%), and 45 (3.7%) patients, respectively. Breast cancer recurred in 184 patients (15.0%); 75 patients died due to breast cancer recurrence, 29 died of other diseases, and 6 died of unknown causes. The univariate hazard ratio (HR) values for disease-free survival and overall survival in the overweight group were significantly lower than those in the normal group. However, there were no statistical significant differences among four groups by the multivariate analysis. We added subgroup analysis with classifications by ER and PgR status to speculate the cause for these unexpected results. Although there were no statistically significant differences, HRs for DFS and OS in the obesity group were higher than those in the normal group among ER- and/or PgR-positive patients. However, HRs for DFS and OS tended to be higher in the underweight groups and lower in the overweight groups in ER- and PgR-negative populations. Conclusions: The incidence of obesity in the Japanese population is much lower than that in the Western population. Although results of this study were slightly different from recent findings, obesity might be a risk factor for DFS and OS in ER-positive Japanese breast cancer patients, similar to that in Western countries. In underweight patients, ER- and PgR-negative status might indicate poor prognosis. However, this study was a retrospective analysis of a limited, heterogeneous patient group. A large-scale cohort study in the Japanese population is, therefore, recommended. [ABSTRACT FROM AUTHOR]