Abstract
BackgroundWith limited sample sizes and single-institution designs, how complete response (CR) after neoadjuvant chemotherapy (NAC) influences breast conserving surgery (BCS) and its value in prognosis are not clear.MethodsA systematic research review was conducted using electronic database. The rate of clinical complete response (cCR) in BCS after NAC and these pathological CR (PCR) and non-pCR BCS patients’ local recurrence-free survival (LRFS), distance recurrence-free survival (DRFS), overall survival (OS), and disease-free survival (DFS) rates were collected. A pooled analysis was performed using a fixed or random effects model and a Q test to determine heterogeneity.ResultsSixteen studies with a total of 4639 patients were included. The pooled data revealed that cCR patients compared with non-cCR patients had significantly higher rates of BCS, with a summary estimate odds ratios (OR) of 4.54 (95% CI 2.03–10.17). The pooled data revealed that BCS patients who achieved pCR after NAC had significantly lower rates of LRFS (RR = 0.59, 95% CI 0.38–0.92) and DRFS (RR = 0.27, 95% CI 0.13–0.55). Better DFS (RR = 0.09, 95% CI 0.04–0.25) and OS (RR = 0.36, 95% CI 0.03–3.90) were also seen, but OS was not significantly different.ConclusionsThe rate of successful BCS is higher in the cCR group than in the non-cCR group, means cCR after NAC can encourage patients to receive BCS. The achievement of pCR after NAC in BCS patients was associated with a good prognosis in terms of LRFS and DRFS, but its value in DFS and OS requires further investigation.
Highlights
With limited sample sizes and single-institution designs, how complete response (CR) after neoadjuvant chemotherapy (NAC) influences breast conserving surgery (BCS) and its value in prognosis are not clear
We investigated whether Pathology complete response (pCR) is a prognostic factor in BCS patients relative to local recurrence-free survival (LRFS), distance recurrence-free survival (DRFS), disease-free survival (DFS), and overall survival (OS) compared with BCS patients who did not achieve pCR
Study selection criteria The published studies to be included in this analysis met the following criteria: (1) a focus on breast cancer patients who were treated with neoadjuvant chemotherapy and received surgery, (2) the presence of evaluations of the associations between CR and outcomes in patients who received either breast conserving surgery or mastectomy surgery, (3) the presence of the necessary information to calculate outcomes (LRFS, DRFS, DFS, or OS) of interest, and (4) availability as a full-text English-language publication
Summary
With limited sample sizes and single-institution designs, how complete response (CR) after neoadjuvant chemotherapy (NAC) influences breast conserving surgery (BCS) and its value in prognosis are not clear. Some studies have reported equal survival benefits between preoperative and postoperative chemotherapy [5,6,7], and with the gradual improvement of postoperative radiotherapy after BCS, BCS after NAC has become more and more accepted. How CR influences BCS is unclear because of limited high-quality data. For these reasons, we collected data on diagnosis, treatment, and prognosis from patients who received BCS after NAC and pooled the results for analysis in this study.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
