Clinical Outcome and Prognostic Factors in Iranian Breast Cancer Patients After Neoadjuvant Chemotherapy: A Comparative Matched Study

Abstract

Background: Breast cancer is the most frequent diagnosed solid cancer with the incidence rate of 32 patients in 100,000 among Iranian women. Neo-adjuvant chemotherapy (NAC) is the standard treatment for patients with locally advanced breast cancer, which was recently introduced for early stage disease to achieve breast preservation. Objectives: The aim of this study was to evaluate the rate of local recurrence, distant recurrence, breast cancer mortality, five years disease free survival (DFS) and five years overall survival (OS) in patients with breast cancer after NAC and to compare these factors with patients, who received adjuvant chemotherapy. Methods: In this cross sectional study, 188 patients with stage I to III breast cancer, who received NAC (group A), and 376 patients with breast cancer, who received adjuvant chemotherapy (group B), were selected and matched based on a time- stratified 2:1 approach between October 2002 and December 2014. Their clinical-pathological profile and survival study were compared. Results: The mean age of patients was 48.23 years in group A and 48.76 years in group B. The median follow-up time was 52 months. In group A and group B, 13.1% and 7.7% of the patients had local recurrence during the five years of follow up, respectively (P < 0.001). In group A and group B, five years PFS rate and five years OS rate was 66% and 70%, and 81.8% and 82.6%, respectively. According to log-rank test analysis, there was no significant difference between two groups as five years DFS and five years OS (P = 0.058 and P = 0.98, respectively). Conclusions: This study showed that higher frequency of local recurrence in NAC group than adjuvant chemotherapy group was not associated with any significant increase in distant recurrence or breast cancer mortality. Longer follow-up time of the patients to compare survival between two groups is recommended.