Local Recurrence after Breast-Conserving Surgery and Mastectomy Following Neoadjuvant Chemotherapy for Locally Advanced Breast Cancer - a Meta-Analysis

Zhou, Xiaodong; Li, Yujie

doi:10.1159/000450626

Cited by 49 publications

(35 citation statements)

References 31 publications

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“…LRFS and DRFS were not significantly different between the BCS and MT groups [ 34 , 35 ] as well as like some studies said, following neoadjuvant chemotherapy [ 36 , 37 ]. However, some researchers found that BCS patients had higher LR after NAC, perhaps because the surgical margins became difficult to accurately assess [ 38 ], some studies reported contrary results that MT group had higher LR rate compared with BCS group [ 18 , 39 ].…”

Section: Discussionmentioning

confidence: 79%

Oncological outcome of complete response after neoadjuvant chemotherapy for breast conserving surgery: a systematic review and meta-analysis

Dai

Chen

et al. 2017

World J Surg Onc

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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.Electronic supplementary materialThe online version of this article (10.1186/s12957-017-1273-6) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 79%

Oncological outcome of complete response after neoadjuvant chemotherapy for breast conserving surgery: a systematic review and meta-analysis

Dai

Chen

et al. 2017

World J Surg Onc

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“…The long-term survival rate among early breast cancer women without NAC who undergo BCS was the same as that among women who undergo radical mastectomy [6][7]. However, several studies have demonstrated no signi cant difference in long-term survival or local recurrence rates between women who underwent BCS and those who underwent radical mastectomy after NAC [8][9]. Although predictive factors for local recurrence in these NAC-treated patient groups have not yet been clari ed yet, the higher local recurrence risk of NAC than of adjuvant chemotherapy is controversial.…”

Section: Introductionmentioning

confidence: 93%

Higher Locoregional Recurrence in Hormone Receptor-Negative Breast Cancer Patients with Residual Disease after Neoadjuvant Treatment Undergoing Breast Conservation Surgery

Chou

Chung

Ding

et al. 2020

Preprint

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Abstract Background: 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). There is still a high locoregional recurrence (LRR) rate after NAC. The aim of this study was to determine predictive factors for locoregional recurrence (LRR) in breast cancer patients after NAC. Materials and Methods: Between 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.Results: The median follow-up time was 45.1 months (range 0.1-160.3 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% and 59%, respectively. Overall, 240 patients experienced tumor recurrence (22.9%). Thirty-five cases of LRR (14.3%) were noted following BCS, of which 4.3% achieved pCR. Multivariate analysis indicated that independent factors for the prediction of LRR included hormone receptor negative/human epidermal growth factor receptor 2 positive (HR-/HER2+) subtype, HR-/HER2- subtype, and failure to achieve pCR. Further investigation according to the molecular subtype showed that following BCS, HR-/HER2+ non-pCR group had significantly increased LRR compared with the HR+/HER2+ pCR group (22.2% vs 6.3%, p<0.05), and the HR-/HER2-non-pCR group had significantly increased LRR compared with the HR-/HER2-pCR group (0% vs 20.4%, p<0.005). Conclusion: Pathological response after NAC is related to the risk of developing LRR. The LRR rate was higher in non-pCR patients after NAC, especially in hormone receptor-negative patients undergoing BCS. Therefore, both the pathological response status and molecular subtype should be carefully considered when considering candidates for BCS after NAC.

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“…Recent evidences seem to refute initial data. In their 2017 metanalysis, Zhou and colleagues reviewed 2000-2015 literature selecting eight trials, with a total of 3,215 patients analyzed: 1,361 receiving BCS and 1,854 who underwent mastectomy (68). At 5 years follow-up, the prevalence of local recurrence was 9.2% in the BCS group, versus 8.3% in the mastectomy group and overall survival was significantly higher in the BCS group, confirming response to NACT a major prognostic factor.…”

Section: Factors Related To Lacking Evidences In Surgical Breast Consmentioning

confidence: 99%

Current weaknesses of breast conserving strategies after neoadjuvant chemotherapy in breast cancer treatment

et al. 2018

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Locally advanced breast cancer (LABC) represents a worldwide major challenge, with a reported incidence reaching up to 90%. In such setting, current guidelines advise for neoadjuvant chemotherapy (NACT) as primary approach to provide effective systemic treatment while surgically down-staging the cancer at presentation. Despite advantages of NACT, ranging a reported locoregional response rate from 30% to 70%, several national surveys still describe higher mastectomy rates than expected. This phenomenon can be ascribed to radiology related factors, as the role of magnetic resonance imaging (MRI), despite having the highest correlation coefficient to final pathology, may still underestimate and overestimate tumor size, leading to surgical over and under treatment; surgeon related factors, as many breast surgeons routinely perform surgery based on pre-treatment characteristics rather than more appropriate posttreatment imaging and clinical results; patient related factors, as there is a well-documented tendency to prefer mastectomy instead of breast conservation therapy (BCT), in an attempt to reach better oncologic outcomes and hospital related factors, as there is too much variability between breast cancer centers, offering modern and minimally-invasive treatments and general hospitals, reporting a difficult access to advanced breast conserving strategies. In this context, the major part of this disinformation sequence in played by an important lacking of strong evidences, mostly regarding the oncologic outcomes of breast conserving surgery (BCS) and oncoplastic surgery (OS). Some recent high impact papers are reporting benefits of OS in LABC treatment, extending beyond improving cosmetic results, to the possibility of obtaining wider excisions with similar oncologic results as observed in patients submitted to classic BCS and mastectomy. Furthermore, what emerges from LABC literature is an imperative need of multidisciplinary breast centers worldwide diffusion, where breast-dedicated oncologists, radiologists and oncoplastic surgeons can offer patient-centered updated diagnostics, treatment protocols and surgical solutions, especially in a very delicate scenario, such as LABC treatment.

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Local Recurrence after Breast-Conserving Surgery and Mastectomy Following Neoadjuvant Chemotherapy for Locally Advanced Breast Cancer - a Meta-Analysis

Cited by 49 publications

References 31 publications

Oncological outcome of complete response after neoadjuvant chemotherapy for breast conserving surgery: a systematic review and meta-analysis

Oncological outcome of complete response after neoadjuvant chemotherapy for breast conserving surgery: a systematic review and meta-analysis

Higher Locoregional Recurrence in Hormone Receptor-Negative Breast Cancer Patients with Residual Disease after Neoadjuvant Treatment Undergoing Breast Conservation Surgery

Current weaknesses of breast conserving strategies after neoadjuvant chemotherapy in breast cancer treatment

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