Abstract
BackgroundNeoadjuvant chemotherapy (NAC) has been the standard treatment for locally advanced breast cancer for the purpose of downstaging or for conversion from mastectomy to breast conservation surgery (BCS). Locoregional recurrence (LRR) rate is still high after NAC. The aim of this study was to determine predictive factors for LRR in breast cancer patients in association with the operation types after NAC.MethodsBetween 2005 and 2017, 1047 breast cancer patients underwent BCS or mastectomy after NAC in Chang Gung Memorial Hospital, Linkou. We obtained data regarding patient and tumor characteristics, chemotherapy regimens, clinical tumor response, tumor subtypes and pathological complete response (pCR), type of surgery, and recurrence.ResultsThe median follow-up time was 59.2 months (range 3.13–186.75 months). The mean initial tumor size was 4.89 cm (SD ± 2.95 cm). Of the 1047 NAC patients, 232 (22.2%) achieved pCR. The BCS and mastectomy rates were 41.3% and 58.7%, respectively. One hundred four patients developed LRR (9.9%). Comparing between patients who underwent BCS and those who underwent mastectomy revealed no significant difference in the overall LRR rate of the two groups, 8.8% in BCS group vs 10.7% in mastectomy group (p = 0.303). Multivariate analysis indicated that independent factors for the prediction of LRR included clinical N2 status, negative estrogen receptor (ER), and failure to achieve pCR. In subgroups of multivariate analysis, only negative ER was the independent factor to predict LRR in mastectomy group (p = 0.025) and hormone receptor negative/human epidermal growth factor receptor 2 positive (HR−/HER2 +) subtype (p = 0.006) was an independent factor to predict LRR in BCS patients. Further investigation according to the molecular subtype showed that following BCS, non-pCR group had significantly increased LRR compared with the pCR group, in HR−/HER2 + subtype (25.0% vs 8.3%, p = 0.037), and HR−/HER2− subtype (20.4% vs 0%, p = 0.002).ConclusionClinical N2 status, negative ER, and failure to achieve pCR after NAC were independently related to the risk of developing LRR. Operation type did not impact on the LRR. In addition, the LRR rate was higher in non-pCR hormone receptor-negative patients undergoing BCS comparing with pCR patients.
Highlights
Neoadjuvant chemotherapy (NAC) has been the standard treatment for locally advanced breast cancer for the purpose of downstaging or for conversion from mastectomy to breast conservation surgery (BCS)
The definition of positive Human epider‐ mal growth factor receptor (HER2) was IHC staining with a score of 3 + or a positive fluorescence in situ hybridization (FISH) test with IHC staining with a score of 2 + . pathological complete response (pCR) was defined as no residual invasive cancer cells in the breast and axillary lymph nodes
A total of 603 patients (57.7%) were prescribed anthracycline-based agents combined with taxane-based regimens, while 325 patients (31.0%) received chemotherapy agents combined with target therapies, of whom 68 patients received dual blockade therapy for HER2 + disease
Summary
Neoadjuvant chemotherapy (NAC) has been the standard treatment for locally advanced breast cancer for the purpose of downstaging or for conversion from mastectomy to breast conservation surgery (BCS). Despite the fact that increased use of NAC has facilitated the treatment of breast cancer, long-term optimized outcomes and treatment effects are concerning. In their recently published meta-analysis on NAC and adjuvant chemotherapy, Asselain and colleagues reported that NAC has a higher local recurrence rate than adjuvant chemotherapy in patients with locally advanced tumors but no significant difference in terms of overall survival between patients undergoing NAC and adjuvant chemotherapy [4]. The frequency of BCS, defined as lumpectomy, with whole breast irradiation, is higher after the use of NAC compared with adjuvant chemotherapy after surgery [4]
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