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. 2023 Apr 25;15(9):2450.
doi: 10.3390/cancers15092450.

Conservative Surgery in cT4 Breast Cancer: Single-Center Experience in the Neoadjuvant Setting

Antonio Franco  1 , Alba Di Leone  1 , Alessandra Fabi  2 , Paolo Belli  3 , Luisa Carbognin  4 , Elisabetta Gambaro  1 , Fabio Marazzi  5 , Elena Jane Mason  1 , Antonino Mulè  6 , Armando Orlandi  7 , Antonella Palazzo  7 , Ida Paris  4 , Alessandro Rossi  8 , Lorenzo Scardina  1 , Daniela Andreina Terribile  1 , Giordana Tiberi  4 , Diana Giannarelli  9 , Giovanni Scambia  10 , Riccardo Masetti  1 , Gianluca Franceschini  1
Affiliations

Conservative Surgery in cT4 Breast Cancer: Single-Center Experience in the Neoadjuvant Setting

Antonio Franco et al. Cancers (Basel). .

Abstract

Background: The diffusion of screening programs has resulted in a decrease of cT4 breast cancer diagnosis. The standard care for cT4 was neoadjuvant chemotherapy (NA), surgery, and locoregional or adjuvant systemic therapies. NA allows two outcomes: 1. improve survival rates, and 2. de-escalation of surgery. This de-escalation has allowed the introduction of conservative breast surgery (CBS). We evaluate the possibility of submitting cT4 patients to CBS instead of radical breast surgery (RBS) by assessing the risk of locoregional disease-free survival, (LR-DFS) distant disease-free survival (DDFS), and overall survival (OS).

Methods: This monocentric, retrospective study evaluated cT4 patients submitted to NA and surgery between January 2014 and July 2021. The study population included patients undergoing CBS or RBS without immediate reconstruction. Survival curves were obtained using the Kaplan-Meyer method and compared using a Log Rank test.

Results: At a follow-up of 43.7 months, LR-DFS was 70% and 75.9%, respectively, in CBS and RBS (p = 0.420). DDFS was 67.8% and 29.7%, respectively, (p = 0.122). OS was 69.8% and 59.8%, respectively, (p = 0.311).

Conclusions: In patients with major or complete response to NA, CBS can be considered a safe alternative to RBS in the treatment of cT4a-d stage. In patients with poor response to NA, RBS remained the best surgical choice.

Keywords: cT4 breast cancer; conservative breast surgery; inflammatory breast cancer; neoadjuvant treatment; oncological outcomes; personalized therapy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Assessment of oncological outcomes of all patients. Patients who underwent RBS appear to have worse outcomes than patients who underwent CBS concerning locoregional recurrence (A); Distant recurrence (B) ant overall survival (C). (LR-DFS: locoregional disease free-survival; DDFS: distant disease free-survival; OS: overall survival).
Figure 2
Figure 2
Assessment of oncological outcomes based on response to NACT. Patients with lower response to NA chemotherapy showed worse systemic outcomes. (LR-DFS: locoregional disease free-survival; DDFS: distant disease free-survival; OS: overall survival).
Figure 3
Figure 3
Assessment of oncological outcomes based on type of surgery in patients with major or complete response to NACT. Use of CBS in patients with major response to chemotherapy does not affect LR-DFS (A). CBS shows the same D-DFS (B) and OS (C) than RBS. (LR-DFS: locoregional disease free-survival; DDFS: distant disease free-survival; OS: overall survival).
See this image and copyright information in PMC

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