Abstract
PurposeThe extended role of breast-conserving surgery (BCS) in the neoadjuvant setting may raise concerns on the oncologic safety of BCS compared to mastectomy. This study compared long-term outcomes after neoadjuvant chemotherapy (NAC) between patients treated with BCS and mastectomy.MethodsAll breast cancer patients treated with NAC from 2008 until 2017 at the Amphia Hospital (the Netherlands) were included. Disease-free and overall survival were compared between BCS and mastectomy with survival functions. Multivariable Cox proportional hazard regression was performed to determine prognostic variables for disease-free survival.Results561 of 612 patients treated with NAC were eligible: 362 (64.5%) with BCS and 199 (35.5%) with mastectomy. Median follow-up was 6.8 years (0.9–11.9). Mastectomy patients had larger tumours and more frequently node-positive or lobular cancer. Unadjusted five-year disease-free survival was 90.9% for BCS versus 82.9% for mastectomy (p = .004). Unadjusted five-year overall survival was 95.3% and 85.9% (p < .001), respectively. In multivariable analysis, clinical T4 (cT4) (HR 3.336, 95% CI 1.214–9.165, p = .019) and triple negative disease (HR 5.946, 95% CI 2.703–13.081, p < .001) were negative predictors and pathologic complete response of the breast (HR 0.467, 95% CI 0.238–0.918, p = .027) and axilla (HR 0.332, 95% CI 0.193–0.572, p = .001) were positive predictors for disease-free survival. Mastectomy versus BCS was not a significant predictor for disease-free survival when adjusted for the former variables (unadjusted HR 2.13 (95%CI: 1.4–3.24), adjusted HR 1.31 (95%CI: 0.81–2.13)). In the BCS group, disease-free and overall survival did not differ significantly between cT1, cT2 or cT3 tumours.ConclusionBCS does not impair disease-free and overall survival in patients treated with NAC. Tumour biology and treatment response are significant prognostic indicators.
Highlights
Over the past 20 years, neoadjuvant chemotherapy is increasingly used in earlystage breast cancer
In patients treated with adjuvant chemotherapy, breast-conserving surgery (BCS) has been shown to be a safe alternative to mastectomy in terms of survival [4,5,6]
From April 2008 until March 2017, a total of 612 nonmetastatic breast cancer patients were treated with neoadjuvant chemotherapy (NAC) at the Amphia Hospital in Breda, the Netherlands
Summary
Over the past 20 years, neoadjuvant chemotherapy (preoperative chemotherapy; NAC) is increasingly used in earlystage breast cancer. Besides in vivo monitoring of treatment response, the tumour load in the breast can be reduced as a result of NAC. This enables surgeons to proceed more often to breast-conserving surgery (BCS) in patients initially scheduled for mastectomy [1]. Breast cancer-specific mortality, on the other hand, was not increased [11] This meta-analysis has several limitations: patients were treated up until 2005, the effect of radiotherapy was not studied and some patients did not undergo any surgery in case of complete clinical/ radiological response to NAC [12]
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