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. 2024 Mar 16;16(6):1169.
doi: 10.3390/cancers16061169.

De-Escalation Surgery in cT3-4 Breast Cancer Patients after Neoadjuvant Therapy: Predictors of Breast Conservation and Comparison of Long-Term Oncological Outcomes with Mastectomy

Corrado Tinterri  1   2 , Erika Barbieri  1 , Andrea Sagona  1 , Alberto Bottini  1 , Giuseppe Canavese  1 , Damiano Gentile  1   2
Affiliations

De-Escalation Surgery in cT3-4 Breast Cancer Patients after Neoadjuvant Therapy: Predictors of Breast Conservation and Comparison of Long-Term Oncological Outcomes with Mastectomy

Corrado Tinterri et al. Cancers (Basel). .

Abstract

Background: Neoadjuvant therapy (NAT) has become increasingly employed for the treatment of cT3-4 breast cancer (BC), enabling breast-conserving surgery (BCS) in cases traditionally considered for mastectomy. This study aims to identify predictors for breast conservation post-NAT and to evaluate whether BCS influences long-term oncological outcomes.

Methods: We retrospectively analyzed data from patients with cT3-4 BC who received NAT at the Breast Unit of IRCCS Humanitas Research Hospital, Milan, Italy, from October 2009 to April 2020. Surgical outcomes and long-term oncological results, such as disease-free survival (DFS), distant DFS (DDFS), overall survival (OS), and BC-specific survival (BCSS), were compared between the BCS and mastectomy groups.

Results: Among 114 patients analyzed, 37 (32.5%) underwent BCS, and 77 (67.5%) had a mastectomy. The key predictors for opting for BCS included absence of vascular invasion, reduced tumor size post-NAT, and achieving ypT0 status. No significant differences in DFS, DDFS, OS, and BCSS were observed between the two surgical groups (log-ranks, p = 0.520, p = 0.789, p = 0.216, p = 0.559, respectively).

Conclusions: BCS after NAT is a feasible and safe option for patients with cT3-4 BC, without adversely affecting long-term oncological outcomes. Identifying predictors of breast conservation can guide surgical decision-making, ensuring that patients receive optimal treatment.

Keywords: breast cancer; breast-conserving surgery; de-escalation; mastectomy; neoadjuvant therapy.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Disease-free survival and distant disease-free survival curves of patients with cT3-4 breast cancer treated with neoadjuvant therapy and surgery (breast-conserving surgery versus mastectomy). BCS: breast-conserving surgery.
Figure 2
Figure 2
Overall survival and breast-cancer-specific survival curves of patients with cT3-4 breast cancer treated with neoadjuvant therapy and surgery (breast-conserving surgery versus mastectomy). BCS: breast-conserving surgery.
See this image and copyright information in PMC

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