Breast-conservation Therapy After Neoadjuvant Chemotherapy Does Not Compromise 10-Year Breast Cancer-specific Mortality.

Abstract

OBJECTIVES:

Neoadjuvant chemotherapy can increase the rate of breast-conserving surgery by downstaging disease in patients with breast cancer. The aim of this study was to determine whether patients who received neoadjuvant chemotherapy have equal survival after breast-conservation therapy compared with mastectomy.

MATERIAL AND METHODS:

Using the New Jersey State Cancer Registry (NJSCR) patients with a primary breast cancer diagnosed between 1998 and 2003 who underwent neoadjuvant chemotherapy were selected (n=1,468). Of those, only patients who received lumpectomy plus radiation (n=276) or mastectomy without radiation (n=442) were included in the analysis. The main outcome measured included 10-year breast cancer-specific mortality, with 90% of patients with known vital status through the end of 2011.

RESULTS:

Baseline characteristics did not differ significantly between the breast-conservation and mastectomy without radiation groups except with respect to summary stage and lymph node involvement. After propensity score matching these differences were no longer statistically significant; however, both estrogen and progesterone status achieved statistical significance. The Kaplan-Meier survival curve showed that the breast-conservation group had significantly higher breast cancer-specific survival than the mastectomy group (P=0.0046). After adjusting for the propensity score in the regression model, the breast-conservation group continued to show significantly better survival than the mastectomy group (hazard ratios, 0.46; 95% confidence interval, 0.27-0.78).

CONCLUSIONS:

This study is consistent with previous research showing that breast-conserving surgery after neoadjuvant chemotherapy does not reduce breast cancer-specific survival. In fact, patients undergoing breast-conservation after neoadjuvant therapy appeared to have better survival than patients undergoing mastectomy without radiation.

• Authors: Renee L Arlow, Lisa E Paddock, Xiaoling Niu, Laurie Kirstein, Bruce G Haffty, Sharad Goyal, Thomas Kearney, Deborah Toppmeyer, Antoinette M Stroup, Atif J Khan
• Journal: American journal of clinical oncology (Am J Clin Oncol) Vol. 41 Issue 12 Pg. 1246-1251 (12 2018) ISSN: 1537-453X [Electronic] United States
• PMID: 29782362 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)

Topics

• Adult
• Aged
• Breast Neoplasms (mortality, pathology, therapy)
• Combined Modality Therapy
• Female
• Follow-Up Studies
• Humans
• Mastectomy (mortality)
• Mastectomy, Segmental (mortality)
• Middle Aged
• Neoadjuvant Therapy (mortality)
• Prognosis
• Retrospective Studies
• Survival Rate
• Young Adult