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. 2021 Jan;185(2):441-451.
doi: 10.1007/s10549-020-05966-y. Epub 2020 Oct 19.

Disease-free and overall survival after neoadjuvant chemotherapy in breast cancer: breast-conserving surgery compared to mastectomy in a large single-centre cohort study

Janine M Simons  1 , Julien G Jacobs  2 , Joost P Roijers  2 , Maarten A Beek  2 , Leandra J M Boonman-de Winter  3 , Arjen M Rijken  2 , Paul D Gobardhan  2 , Jan H Wijsman  2 , Eric Tetteroo  4 , Joan B Heijns  5 , C Y Yick  6 , Ernest J T Luiten  2
Affiliations

Disease-free and overall survival after neoadjuvant chemotherapy in breast cancer: breast-conserving surgery compared to mastectomy in a large single-centre cohort study

Janine M Simons et al. Breast Cancer Res Treat. 2021 Jan.

Abstract

Purpose: The 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.

Methods: All 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.

Results: 561 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.

Conclusion: BCS does not impair disease-free and overall survival in patients treated with NAC. Tumour biology and treatment response are significant prognostic indicators.

Keywords: Breast cancer; Breast-conserving surgery; Lumpectomy; Mastectomy; Neoadjuvant chemotherapy; Survival.

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Conflict of interest statement

All authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Consort flow diagram for included patients
Fig. 2
Fig. 2
Unadjusted survival functions for disease-free survival by type of breast surgery (including numbers at risk)
Fig. 3
Fig. 3
Unadjusted survival functions for overall survival by type of breast surgery (including numbers at risk)
Fig. 4
Fig. 4
Adjusted survival functions for disease-free survival by type of breast surgery
See this image and copyright information in PMC

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