# Long-Term Prognostic Risk After Neoadjuvant Chemotherapy Associated With Residual Cancer Burden and Breast Cancer Subtype

Source: https://onco.cc/key-papers/paper-symmans-rcb-long-term-prognosis-subtype-jco-2017/  
OnCo record `paper-symmans-rcb-long-term-prognosis-subtype-jco-2017` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The 2017 validation of the residual cancer burden score, which graded how much triple-negative tumour is left after pre-surgery chemotherapy and found ten-year relapse-free survival of 86 percent with no residual tumour, 81 percent with minimal, 55 percent with moderate and 23 percent with extensive residual disease.

## Summary

Symmans, Wei, Gould, Yu and colleagues measured the continuous residual cancer burden index (pathological complete response is 0; residual disease falls into RCB-I, II and III) and yp-stage in five prospectively followed cohorts: three receiving paclitaxel then fluorouracil, doxorubicin and cyclophosphamide (219, 262 and 342 patients), one receiving FAC alone (132) and one receiving trastuzumab with paclitaxel and FEC (203), with median event-free follow-up of 13.5, 9.1, 6.8, 16.4 and 7.1 years. Continuous residual cancer burden was prognostic within each subset independent of other variables, and RCB classes stratified risk overall, within subsets and within yp-stage. Ten-year relapse-free survival for pathological complete response, RCB-I, RCB-II and RCB-III was 86, 81, 55 and 23 percent for triple-negative disease; 83, 97, 74 and 52 percent for hormone receptor-positive/HER2-negative disease; and 95, 77, 47 and 21 percent in the trastuzumab cohort.

## Fields

- Kind: Key paper
- Last checked: 2026-09-24
- Tags: tnbc-evidence
- Journal: Journal of Clinical Oncology
- Year: 2017
- DOI: 10.1200/JCO.2015.63.1010
- Authors: Symmans WF, Wei C, Gould R, et al.
- Findings: Ten-year relapse-free survival in triple-negative disease by residual cancer burden class: 86 percent (complete response), 81 (RCB-I), 55 (RCB-II), 23 (RCB-III).; Continuous residual cancer burden prognostic within every phenotypic subset, independent of clinical and pathological variables.
- What it means: Turned residual disease from yes or no into a graded score; RCB II and III are now the entry criteria for post-neoadjuvant trials (ASCENT-05, TROPION-Breast03) and the population the ctDNA-guided idea targets.
- Caveats: Single institution; the authors call for external validation, supplied by the 2022 pooled analysis.; Pre-immunotherapy chemotherapy regimens.

## Sources

- J Clin Oncol 2017: https://doi.org/10.1200/JCO.2015.63.1010
- PubMed: https://pubmed.ncbi.nlm.nih.gov/28135148/

## Connected records

- key papers: [Measurement of residual breast cancer burden to predict survival after neoadjuvant chemotherapy](https://onco.cc/key-papers/paper-symmans-j-clin-oncol/), [Residual cancer burden after neoadjuvant chemotherapy and long-term survival outcomes in breast cancer: a multicentre pooled analysis of 5161 patients](https://onco.cc/key-papers/paper-yau-rcb-pooled-analysis-5161-lancet-oncol-2022/)
- cancers: [HER2-positive breast cancer](https://onco.cc/cancers/breast-her2-positive/), [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/), [Triple-negative breast cancer (TNBC)](https://onco.cc/cancers/tnbc/)
- institutions: [MD Anderson Cancer Center](https://onco.cc/institutions/md-anderson/)
- terms: [Neoadjuvant / adjuvant / perioperative](https://onco.cc/terms/neoadjuvant-adjuvant/), [Pathologic complete response (pCR)](https://onco.cc/terms/pcr/), [Residual cancer burden (RCB)](https://onco.cc/terms/rcb/)
- trials: [ASCENT-05 / OptimICE-RD (AFT-65, GBG 119, NSABP B-63)](https://onco.cc/trials/ascent-05/), [TROPION-Breast03](https://onco.cc/trials/tropion-breast03/)
- journals: [Journal of Clinical Oncology](https://onco.cc/journals/jco/)
- roadmaps: [Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem](https://onco.cc/roadmaps/tnbc-roadmap/)
- ideas: [ctDNA-guided adjuvant decisions after residual disease: escalate the positive, spare the negative](https://onco.cc/ideas/idea-tnbc-ctdna-guided-adjuvant-decisions/)

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