Risk factors for locoregional disease recurrence after breast‐conserving therapy in patients with breast cancer treated with neoadjuvant chemotherapy: An international collaboration and individual patient meta‐analysis

Valachis, Antonios; Mamounas, Eleftherios P.; Mittendorf, Elizabeth A.; Hayashi, Naoki; Ishitobi, Makoto; Natoli, Clara; Fitzal, Florian; Rubio, Isabel T.; Tiezzi, Daniel Guimarães; Shin, Hyopil; Anderson, Stewart J.; Hunt, Kelly K.; Matsuda, Naoko; Ohsumi, Shozo; Totomi, Athina; Nilsson, Cecilia

doi:10.1002/cncr.31518

Cited by 49 publications

(23 citation statements)

References 33 publications

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“…The reason for the excellent outcome is related to the introduction in routine clinical practice of highly effective treatments in specific subtypes of breast cancer, in particular anti‐HER2 agents. Five‐year LRR rates in our study were similar to other reported cohorts 8,30 …”

Section: Discussionsupporting

confidence: 91%

“…Five-year LRR rates in our study were similar to other reported cohorts. 8,30 5 | CONCLUSION Additional step forward towards optimal selection of patients who will benefit from de-escalating in locoregional treatments after NAT is ongoing. It will impact on reducing morbidity while achieving equal or better long-term outcomes, and reflects the real multidisciplinary breast cancer care at the Institutional level.…”

Section: Locoregional Recurrence and Survival Ratesmentioning

confidence: 99%

“…The use of different methods of guiding BCS have decreased re‐excision rates, reduced volume of healthy tissue excised, and have supported the concept that there is no need to excise the pretreatment volume of tumor 5,6 . It is also important to realize that many of the risk factors for locoregional recurrence (LRR) after BCS also predict for LRR after mastectomy 7,8 . Rates of BCS after NAT have increased in HER2 positive and TN breast cancer who achieve an excellent response, 9 rates that historically had been the lowest 10 .…”

Section: Introductionmentioning

confidence: 99%

“…many of the risk factors for locoregional recurrence (LRR) after BCS also predict for LRR after mastectomy. 7,8 Rates of BCS after NAT have increased in HER2 positive and TN breast cancer who achieve an excellent response, 9 rates that historically had been the lowest. 10 There is now enough evidence to suggest that, in the multidisciplinary management of breast cancer, BCS after NAT is safe and effective for adequately selected patients.…”

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confidence: 99%

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Leveraging the increased rates of pathologic complete response after neoadjuvant treatment in breast cancer to de‐escalate surgical treatments

Esgueva

Siso

Espinosa-Bravo

et al. 2020

Journal of Surgical Oncology

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Introduction: Breast conservative surgery (BCS) and sentinel lymph node biopsy (SLNB) after neoadjuvant treatment (NAT) is safe and effective for selected patients. This aim of this study is to evaluate the impact of anatomic site of response on outcomes and to assess the real population who may benefit from nonsurgical approaches after NAT. Material and Methods: From a prospectively maintained database, patients with T1-4 N0-2 breast cancer undergoing NAT were identified. Clinicopathological and survival rates were compared in relation to response and anatomic site of response. Results: Six hundred and forty-six patients were included in the study. Pathologic complete response (pCR) was an independent factor for BCS and SLN. HER2 positive and TN tumors with cN0 achieving a breast pCR remain ypN0 (p = .002). Residual axillary disease was associated with breast residual tumor (p = .05) and subtype (p = .001). With a median follow up of 35.25 months, patients with any pCR had improved survival when compared with partial response, but not significant differences between pCR, axillary pCR, or breast pCR. Conclusion: Achieving a pCR increases BCS and SLN. In selected subgroups, sparing any axillary surgery after NAT maybe feasible. In cN+ patients, any pCR was associated with survival, but not the anatomic site of response.

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Section: Discussionsupporting

confidence: 91%

Section: Locoregional Recurrence and Survival Ratesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Leveraging the increased rates of pathologic complete response after neoadjuvant treatment in breast cancer to de‐escalate surgical treatments

Esgueva

Siso

Espinosa-Bravo

et al. 2020

Journal of Surgical Oncology

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“…While subtype was not analysed in that trial, other significant independent predictors were age and clinical node status. The effect different subtypes have on recurrence rates in patients treated with NAC has been demonstrated by several other studies [26][27][28][29][30][31], where the HR-negative/HER2-positive and triple negative subtypes are associated with increased recurrence rates.…”

Section: Discussionmentioning

confidence: 67%

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

Simons

Jacobs

Roijers

et al. 2020

Breast Cancer Res Treat

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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.

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Is local recurrence higher among patients who downstage to breast conservation after neoadjuvant chemotherapy?

Mamtani

Sevilimedu

et al. 2021

Cancer

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BACKGROUND:In early studies, local recurrence (LR) rates were higher after neoadjuvant chemotherapy (NAC) in comparison with upfront surgery. Modern outcomes are uncertain, particularly among those who are initially breast-conserving surgery-ineligible (BCSi) and downstage to being breast-conserving surgery-eligible (BCSe). METHODS: Among patients with cT1-3 breast cancer treated from 2014 to 2018 who were BCSe after NAC, clinicopathologic characteristics and LR were compared between initially BCSe patients and BCSi patients who downstaged. Breast-conserving surgery (BCS) eligibility was determined prospectively. RESULTS: Among 685 patients, 243 (35%) were BCSe before and after NAC and had BCS; 282 (41%) were BCSi before NAC, downstaged to BCSe, and had BCS; and 160 (23%) were BCSi before NAC, downstaged to BCSe, and chose mastectomy. The median age was 52 years, and most cancers were cT1-2 (84%), cN+ (61%), and human epidermal growth factor receptor 2-positive (HER2+; 38%) or triple-negative (34%). Those who were BCSe before NAC had a lower cT stage, whereas those who chose mastectomy were younger (P < .05). NAC was usually ACT (doxorubicin, cyclophosphamide, and a taxane)-based (92%), 99% of HER2+ patients received dual blockade, and 99% of BCS patients received adjuvant radiation. At a median follow-up of 35 months, 22 patients (3.2%) had developed LR. The Kaplan-Meier 4-year LR rates were not different among the groups (1.9% for those who were BCSe before and after NAC, 6.3% for those who downstaged to being BCSe and underwent BCS, and 2.7% for those who downstaged and underwent mastectomy; P = .17). CONCLUSIONS: LR rates are low after NAC and BCS, even among BCSi patients who downstage, and they are not improved in patients who downstage and choose mastectomy. Mastectomy can be safely avoided in BCSi patients who downstage with NAC.

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Risk factors for locoregional disease recurrence after breast‐conserving therapy in patients with breast cancer treated with neoadjuvant chemotherapy: An international collaboration and individual patient meta‐analysis

Cited by 49 publications

References 33 publications

Leveraging the increased rates of pathologic complete response after neoadjuvant treatment in breast cancer to de‐escalate surgical treatments

Leveraging the increased rates of pathologic complete response after neoadjuvant treatment in breast cancer to de‐escalate surgical treatments

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

Is local recurrence higher among patients who downstage to breast conservation after neoadjuvant chemotherapy?

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