A Preliminary Comparative Study on Clinical and Pathologic Response Patterns of Breast Cancer in Ghanaian Women Undergoing Neoadjuvant Chemotherapy and Hormonal Therapy

Response to neoadjuvant chemotherapy in locally advanced breast cancer can be evaluated clinically, radiologically, or pathologically. Preliminary Ghanaian studies utilised clinical means; however, the gold standard is pathological assessment, with recent reports showing discrepancies between the two modes of assessment. This study sought to compare clinical and pathological responses in Ghanaian women undergoing neoadjuvant chemotherapy.

A total of 56 participants with locally advanced breast cancer were managed via a multidisciplinary team at Komfo Anokye Teaching Hospital. Clinicopathologic staging was done prior to the start of neoadjuvant chemotherapy, followed by surgery. Immunohistochemistry profiles were assessed for 31 subjects who could afford it. Analysis of clinical and pathologic responses to neoadjuvant chemotherapy was done using the Response Evaluation Criteria in Solid Tumors guidelines and Miller and Payne criteria, respectively.

Phenotypic subtyping undertaken for 31 study participants revealed a predominance (54.8%) of triple-negative (TN) followed by the luminal A (29.0%) subtype. The main neoadjuvant chemotherapy regimen utilised was adriamycin-cyclophospahamide (85.7%). Complete clinical response was higher among the TN (22.6%) subtypes, and partial response was somehow equally distributed between the TN (9.4%) and luminal type A (18.5%). Complete pathological response occurred in six cases of TN, whilst 11 cases showed partial response ranging from grade 1 to 4. Spearman's correlation between the clinical and pathologic responses showed a negative correlation between the two arms (rs = -0.476, P < 0.01).

The significant discrepancy between clinical and pathologic responses analysed within the limited subtypes in this preliminary study underscores the need to assess pathologic response patterns.