Prognosis after neo-adjuvant chemotherapy

How do you asses prognosis after neo-adjuvant chemo?  Is it based on residual disease found after surgery or tumor size at diagnosis?  Can you point me to any studies published on this subject?  Thanks for information.

[CCF-RN,MSN-JS]

Dear Gollita, There are many factors that effect treatment recommendations made in the course of treatment of breast cancer.  A prognostic factor is defined as a measurement that is associated with disease-free or overall survival without use of adjuvant systemic therapy.  A predictive factor is any measurement associated with response or lack of response to a particular therapy.  Evaluating potential prognostic and predictive factors requires caution.  Individual studies often evaluate many factors and report only the statistically significant ones.  It has also been reported that certain prognostic factors may only be important in the first 5 years after primary treatment, but not with long-term follow-up.

So prognostic factors that are currently established are things like lymph node status, tumor size, and certain tumor characteristics.   Age at diagnosis, biochemical measurements such as estrogen receptor status of the tumor, and presence of HER-2/neu growth factors, are other factors that influence prognostication (or the likelihood of recommendation of adjuvant or in your case neo-adjuvant therapy).

Regarding predictive factors for neoadjuvant therapy (whether it is associated with response or not), data continues to be gathered.  In a Medline search there were various studies found, which were looking at different angles of this issue.  In the Journal of Clinical Oncology there were 2 studies in the past couple of months, one entitled

[Afroza]

Actual prognosis depends on special pathology of the tumor. ER/PR status, etc. The tumor size is only a virtual issue.