Clinical Impact of Delaying Surgery in Patients Undergoing Neoadjuvant Chemotherapy on Breast Cancer Recurrence and Survival

Abstract

Background: For patients with breast cancer, the optimal time of surgery after completion of neoadjuvant chemotherapy (NAC) is unknown. Aim: We evaluated the association between time to surgery after NAC completion and disease free survival (DFS) and overall survival (OS). Methods: Women diagnosed with breast cancer stages I to III between 2013-2016 who received NAC at our institution were included. Patients were categorized into two groups according to time to surgery after completion of NAC ≤ 60 days, and > 60 days. Survival outcomes were estimated and compared according to time to surgery after NAC completion. Statistical analysis was done using the Kaplan-Meier estimate. Groups were then compared by log rank. Results: In total, 58 patients treated with NAC were included in the study. The median interval to surgery after completion of NAC was 29 days. Five-year DFS was 82% for patients with surgery < 60 days and 63% for patients with surgery > 60 days after NAC completion (log rank z=2.32, P = 0.02). A surgery date of > 60 days after NAC completion was associated with shorter DFS. Five-year OS was 89% for patients with surgery < 60 days and 90% for patients > 60 days after NAC completion (log rank z=0.14, P = 0.89). A surgery date of > 60 days after NAC completion was not associated with a poorer overall survival. Conclusion: Time to surgery after completion of NAC influenced recurrence outcomes but not overall survival in our study cohort. Our findings suggest that the timing of surgery after completion of NAC is crucial for recurrence, but not survival, for patients undergoing NAC.