Evaluación de la respuesta patológica a la terapia neoadyuvante en pacientes con cáncer de mama tratados en ONCOSERV

Evaluation of Pathological Response to Neoadjuvant Therapy in Breast Cancer Patients Treated at ONCOSERV

Authorship SCIMAGO INSTITUTIONS RANKINGS

Introduction: Pathological complete response (pCR) following neoadjuvant therapy in breast cancer is a key prognostic marker associated with improved survival. However, in the Dominican Republic, data on factors associated with pCR remain limited. This study evaluates the frequency of pCR and its associated factors in patients treated at ONCOSERV.

Methods: We conducted an observational, retrospective, and analytical cross-sectional study based on medical records of breast cancer patients who underwent neoadjuvant therapy between 2021 and 2023. Sociodemographic, clinical, and therapeutic variables were analyzed. Logistic regression models were used to assess associations with pCR.

Results: A total of 110 patients were included, with a pCR rate of 30%. The probability of pCR was lower in patients with advanced clinical stages (OR=0.287; 95% CI: 0.117-0.637; p=0.004) and those with poorer functional status (OR=0.281; 95% CI: 0.089-0.738; p=0.017). pCR was more frequent in patients with HER2+/HR+ tumors (OR=4.373; 95% CI: 1.141-17.970; p=0.034). A diagnostic delay of more than five weeks significantly reduced pCR in patients with advanced stages (OR=0.066; 95% CI: 0.010-0.350; p=0.002) and those with subsidized health insurance (OR=0.158; 95% CI: 0.026-0.874; p=0.037).

Conclusions: Clinical stage, functional status, molecular profile, educational level, and health insurance type influence pCR. Diagnostic delays negatively impact treatment response, underscoring the need for strategies to improve access and equity in oncological care.

Keywords:
breast cancer; neoadjuvant therapy; pathological response; health inequities

Características de las pacientes	General (n = 110)	Grupo de edad		p value
Características de las pacientes	General (n = 110)	50 o menos (n = 47)	Mayor de 50 (n = 63)	p value
Escolaridad
Básica	33 (30.0%)	6 (12.8%)	27 (42.9%)	0.003
Secundaria	47 (42.7%)	24 (51.1%)	23 (36.5%)
Universitaria	30 (27.3%)	17 (36.2%)	13 (20.6%)
Estado civil
Soltera	39 (35.5%)	20 (42.6%)	19 (30.2%)	0.010
Casada	25 (22.7%)	10 (21.3%)	15 (23.8%)
Unión libre	30 (27.3%)	16 (34.0%)	14 (22.2%)
Viuda	16 (14.5%)	1 (2.1%)	15 (23.8%)
Nacionalidad
Dominicana	104 (94.5%)	44 (93.6%)	60 (95.2%)	0.999
Haitiana	6 (5.5%)	3 (6.4%)	3 (4.8%)
Seguro social
Privado	50 (45.5%)	25 (53.2%)	25 (39.7%)	0.281
Subsidiado	59 (53.6%)	22 (46.8%)	37 (58.7%)
No aplica (Pensionado)	1 (0.9%)	0 (0%)	1 (1.6%)
Estado funcional inicial
0	10 (9.1%)	2 (4.3%)	8 (12.7%)	0.254
1	78 (70.9%)	36 (76.6%)	42 (66.7%)
2	15 (13.6%)	7 (14.9%)	8 (12.7%)
3	2 (1.8%)	0 (0%)	2 (3.2%)
Desconocido	5 (4.5%)	2 (4.3%)	3 (4.8%)
Estadio clínico inicial
I	1 (0.9%)	0 (0%)	1 (1.6%)	0.865
II	47 (42.7%)	20 (42.6%)	27 (42.9%)
III	53 (48.2%)	22 (46.8%)	31 (49.2%)
IV	7 (6.4%)	3 (6.4%)	4 (6.3%)
Desconocido	2 (1.8%)	2 (4.3%)	0 (0%)
Tipo histológico
Carcinoma ductal infiltrante	96 (87.3%)	42 (89.4%)	54 (85.7%)	0.112
Carcinoma lobulillar infiltrante	8 (7.3%)	1 (2.1%)	7 (11.1%)
Otro	2 (1.8%)	0 (0%)	2 (3.2%)
Desconocido	4 (3.6%)	4 (8.5%)	0 (0%)
Perfil molecular
Luminal A	36 (32.7%)	7 (14.9%)	29 (46.0%)	0.002
Luminal B	26 (23.6%)	9 (19.1%)	17 (27.0%)
Triple negativo	26 (23.6%)	17 (36.2%)	9 (14.3%)
Her 2 sobre expresado RH-	3 (2.7%)	2 (4.3%)	1 (1.6%)
Her 2+ con RH+	17 (15.5%)	10 (21.3%)	7 (11.1%)
Desconocido	2 (1.8%)	2 (4.3%)	0 (0%)
Tratamiento neoadyuvante
Quimioterapia	104 (94.5%)	47 (100%)	57 (90.5%)	0.094
Hormonoterapia	5 (4.5%)	0 (0%)	5 (7.9%)
Inmunoterapia	1 (0.9%)	0 (0%)	1 (1.6%)
Régimen empleado
A/C/ taxanos	42 (38.2%)	22 (46.8%)	20 (31.7%)	0.061
Taxanos	32 (29.1%)	8 (17.0%)	24 (38.1%)
Platinos + taxanos/ A/C	9 (8.2%)	5 (10.6%)	4 (6.3%)
Pembrolizumab + QT	2 (1.8%)	1 (2.1%)	1 (1.6%)
BHC	2 (1.8%)	0 (0%)	2 (3.2%)
Otro	14 (12.7%)	9 (19.1%)	5 (7.9%)
Desconocida	9 (8.2%)	2 (4.3%)	7 (11.1%)
Procedimiento quirúrgico
Mastectomía radical modificada	89 (80.9%)	38 (80.9%)	51 (81.0%)	0.627
Cuadrantectomía + Biopsia de ganglio centinela	9 (8.2%)	3 (6.4%)	6 (9.5%)
Ninguno	5 (4.5%)	3 (6.4%)	2 (3.2%)
No aplica	2 (1.8%)	1 (2.1%)	1 (1.6%)
Desconocido	5 (4.5%)	2 (4.3%)	3 (4.8%)
Respuesta clínica
Respuesta completa	54 (49.1%)	21 (44.7%)	33 (52.4%)	0.842
Respuesta parcial	38 (34.5%)	18 (38.3%)	20 (31.7%)
Enfermedad Estable	13 (11.8%)	6 (12.8%)	7 (11.1%)
Progresión	3 (2.7%)	1 (2.1%)	2 (3.2%)
Desconocida	2 (1.8%)	1 (2.1%)	1 (1.6%)
Respuesta patológica
Respuesta patológica completa (RPC)	33 (30.0%)	16 (34.0%)	17 (27.0%)	0.036
Respuesta patológica parcial (RPP)	70 (63.6%)	27 (57.4%)	43 (68.3%)
Sin respuesta	4 (3.6%)	4 (8.5%)	0 (0%)
Progresión	3 (2.7%)	0 (0%)	3 (4.8%)
Tiempo transcurrido entre llegada al centro y diagnóstico
1-2 semanas	13 (11.8%)	6 (12.8%)	7 (11.1%)	0.579
3-4 semanas	39 (35.5%)	16 (34.0%)	23 (36.5%)
5-7 semanas	27 (24.5%)	9 (19.1%)	18 (28.6%)
8-12 semanas	12 (10.9%)	5 (10.6%)	7 (11.1%)
13 o más semanas	19 (17.3%)	11 (23.4%)	8 (12.7%)
Tiempo transcurrido entre llegada al centro e inicio tratamiento
1-2 semanas	47 (42.7%)	22 (46.8%)	25 (39.7%)	0.194
3-4 semanas	48 (43.6%)	17 (36.2%)	31 (49.2%)
5-7 semanas	9 (8.2%)	3 (6.4%)	6 (9.5%)
8-12 semanas	4 (3.6%)	3 (6.4%)	1 (1.6%)
13 o más semanas	2 (1.8%)	2 (4.3%)	0 (0%)

Variables de exposición	OR	IC 95%		P valor
Variables de exposición	OR	Inferior	Superior	P valor
Edad: ≤ 40 (Ref.)
Edad: 40 - 49	0.642	0.166	2.585	0.520
Edad: 50 - 64	0.587	0.157	2.297	0.428
Edad: ≥ 65	0.373	0.071	1.821	0.225
Escolaridad: Básica (Ref.)
Escolaridad: Secundaria	3.047	0.969	11.699	0.073
Escolaridad: Universitaria	3.763	1.101	15.280	0.044
Seguro social: Privado (Ref.)
Seguro social: Subsidiado	0.309	0.109	0.803	0.020
Nacionalidad: Dominicana (Ref.)
Nacionalidad: Haitiana	1.177	0.157	6.362	0.855
Estado civil: Soltera (Ref.)
Estado civil: Casada o unida	0.799	0.334	1.919	0.613
Estado civil: Viuda	0.255	0.037	1.093	0.098

Variables de exposición	OR	IC 95%		P valor
Variables de exposición	OR	Inferior	Superior	P valor
Modelos ajustados
Estadio	0.287	0.117	0.637	0.004
Estado funcional inicial	0.281	0.089	0.738	0.017
Tipo histológico: Carcinoma ductal infiltrante (Ref.)
Tipo histológico: Otro	0.202	0.010	1.228	0.147
Perfil molecular: Luminal A (Ref.)
Perfil molecular: Luminal B	2.501	0.728	9.081	0.149
Perfil molecular: Triple negativo	2.803	0.779	10.744	0.119
Perfil molecular: Her 2 sobre expresado RH-	*	*	*	*
Perfil molecular: Her 2+ con RH+	4.373	1.141	17.970	0.034

Variables de exposición	OR	IC 95%		P valor
Variables de exposición	OR	Inferior	Superior	P valor
Tratamiento: Quimioterapia (Ref.)
Tratamiento: Otro	1.845	0.250	37.878	0.598
Régimen empleado: A/C/ taxanos (Ref.)
Régimen empleado: Taxanos	0.880	0.301	2.506	0.812
Régimen empleado: Otro	1.122	0.389	3.169	0.829
Procedimiento quirúrgico: Mastectomía radical modificada (Ref.)
Procedimiento quirúrgico: Cuadrantectomía + Biopsia de ganglio centinela	3.191	0.732	14.834	0.121
Tiempo de diagnóstico: 1-2 semanas (Ref.)
Tiempo de diagnóstico: 3-4 semanas	0.968	0.243	4.351	0.964
Tiempo de diagnóstico: 5-7 semanas	1.447	0.346	6.821	0.621
Tiempo de diagnóstico: 8-12 semanas	1.179	0.208	6.771	0.850
Tiempo de diagnóstico: 13 semanas o más	0.647	0.112	3.719	0.619
Tiempo inicio tratamiento: 1-2 semanas (Ref.)
Tiempo inicio tratamiento: 3-4 semanas	0.770	0.305	1.929	0.577
Tiempo inicio tratamiento: 5-7 semanas	0.528	0.071	2.579	0.464
Tiempo inicio tratamiento: 8-12 semanas	0.524	0.024	4.731	0.597
Tiempo de diagnóstico: superior de 5 semanas * Seguro social: subsidiado	0.158	0.026	0.874	0.037
Tiempo de diagnóstico: superior de 5 semanas * Estadio al diagnóstico	0.066	0.010	0.350	0.002

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Instituto Tecnológico de Santo Domingo Santo Domingo DN, Dominican Republic Av. Los Próceres, Jardines del Norte. P.O. Box 342-9 and 249-2 - E-mail: manuel.colome@intec.edu.do

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