# Residual cancer burden after neoadjuvant chemotherapy and long-term survival outcomes in breast cancer: a multicentre pooled analysis of 5161 patients

Source: https://onco.cc/key-papers/paper-yau-rcb-pooled-analysis-5161-lancet-oncol-2022/  
OnCo record `paper-yau-rcb-pooled-analysis-5161-lancet-oncol-2022` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A pooled analysis of 5,161 patients from 12 European and US institutions and trials confirming that the residual cancer burden score predicts relapse in every breast cancer subtype, and proposing it become part of standard pathology reporting after pre-surgery chemotherapy.

## Summary

Yau, Osdoit, van der Noordaa, Shad and colleagues obtained participant-level residual cancer burden results and clinical data from 12 institutes and trials in Europe and the USA for patients with stage I to III breast cancer treated with neoadjuvant chemotherapy and surgery between September 1994 and February 2019 (5,161 patients, median age 49, median follow-up 56 months, 1,164 events). Higher residual cancer burden was associated with worse event-free survival within each subtype: the univariable hazard ratio per unit ranged from 1.55 (95 percent confidence interval 1.41 to 1.71) in hormone receptor-positive/HER2-negative disease to 2.16 (1.79 to 2.61) in hormone receptor-negative/HER2-positive disease (p<0.0001 for all), and remained prognostic after adjustment for age, grade, T category and nodes (adjusted hazard ratios 1.52 to 2.09). The authors conclude the score and class are independently prognostic in all subtypes and generalisable across practice settings.

## Fields

- Kind: Key paper
- Last checked: 2026-09-24
- Tags: tnbc-evidence
- Journal: The Lancet Oncology
- Year: 2022
- DOI: 10.1016/S1470-2045(21)00589-1
- Authors: Yau C, Osdoit M, van der Noordaa M, et al.
- Findings: Hazard ratio per unit residual cancer burden 1.55 to 2.16 across subtypes (p<0.0001 for all); adjusted 1.52 to 2.09.; Prognostic in every subtype across 12 cohorts from 1994 to 2019.
- What it means: The external validation the 2017 paper asked for; it is why residual cancer burden is reported in UK and European pathology and used as a trial entry criterion rather than an MD Anderson curiosity.
- Caveats: Retrospective pooling with variable subtype definitions and treatments.; Follow-up shorter than the single-institution cohorts.

## Sources

- Lancet Oncol 2022: https://doi.org/10.1016/S1470-2045(21)00589-1
- PubMed: https://pubmed.ncbi.nlm.nih.gov/34902335/

## Connected records

- key papers: [Long-Term Prognostic Risk After Neoadjuvant Chemotherapy Associated With Residual Cancer Burden and Breast Cancer Subtype](https://onco.cc/key-papers/paper-symmans-rcb-long-term-prognosis-subtype-jco-2017/)
- 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: [National Cancer Institute (NIH)](https://onco.cc/institutions/nci/)
- terms: [Event-free / disease-free survival (EFS, DFS, iDFS, RFS)](https://onco.cc/terms/efs/), [Hazard ratio (HR)](https://onco.cc/terms/hazard-ratio/), [Residual cancer burden (RCB)](https://onco.cc/terms/rcb/)
- journals: [The Lancet Oncology](https://onco.cc/journals/lancet-oncology/)
- 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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