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

Frederik Marme, Christine Solbach, Laura Michel, Andreas Schneeweiss, Jens-Uwe Blohmer, Jens Huober, Peter A Fasching, Christian Jackisch, Valentina Nekljudova, Theresa Link, Kerstin Rhiem, Julia Rey, Carsten Denkert, Claus Hanusch, Hans Tesch, Bianca Lederer, Sibylle Loibl & Michael Untch

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.
   
citation Marme F, Solbach C, Michel L, Schneeweiss A, Blohmer J U, Huober J, Fasching P A, Jackisch C, Nekljudova V, Link T, Rhiem K, Rey J, Denkert C, Hanusch C, Tesch H, Lederer B, Loibl S, Untch M. Utility of the CPS + EG scoring system in triple-negative breast cancer treated with neoadjuvant chemotherapy. Eur J Cancer 2021; 153:203-212.
   
type journal paper/review (English)
date of publishing 26-06-2021
journal title Eur J Cancer (153)
ISSN electronic 1879-0852
pages 203-212
PubMed 34186505
DOI 10.1016/j.ejca.2021.05.027