Oncological safety of breast-conserving surgery after primary systemic chemotherapy in cT3-4 breast cancer patients

Surg Today. 2015 Oct;45(10):1255-62. doi: 10.1007/s00595-014-1052-8. Epub 2014 Oct 19.

Abstract

Purpose: The aim of this study was to retrospectively assess the oncological safety of breast-conserving surgery (BCS) after primary systemic chemotherapy (PST) in terms of local recurrence (LR) in cT3-4 patients.

Methods: The subjects were 146 cT1-2 patients who underwent BCS after PST, and 169 patients with cT3-4 primary breast cancer. Of the 169 patients with cT3-4 disease, 20 underwent surgery first, and 149 underwent surgery after PST (mastectomy: 101 patients; BCS: 48 patients). The LR-free survival (LRFS) was analyzed using a Kaplan-Meier analysis. We evaluated the predictors using Cox proportional hazards modeling for LR after PST.

Results: There was no significant difference in 5-year LRFS between the cT1-2 and cT3-4 groups that underwent BCS after PST (98.6 vs. 92.5 %; P = 0.074). The 5-year LRFS was 94.7 % in the group that underwent initial surgery and 93.0 % in the PST group (P = 0.845) in the cT3-4 patients, while the 5-year LRFS rates were 93.2 % in the BCS subgroup and 92.5 % in the mastectomy subgroup (P = 0.958). In a multivariate analysis, the histological type, hormone negativity and a higher histological grade were independent predictors of LR after PST.

Conclusions: BCS after PST may be oncologically acceptable for cT3-4 breast cancers in terms of the LR compared with initial surgery or mastectomy after PST.

Keywords: Breast-conserving surgery; Local recurrence; Primary systemic chemotherapy.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents / administration & dosage*
  • Breast Neoplasms / drug therapy
  • Breast Neoplasms / mortality
  • Breast Neoplasms / pathology*
  • Breast Neoplasms / surgery*
  • Female
  • Follow-Up Studies
  • Humans
  • Kaplan-Meier Estimate
  • Mastectomy / methods*
  • Mastectomy, Segmental / methods*
  • Middle Aged
  • Neoplasm Recurrence, Local / prevention & control
  • Neoplasm Staging*
  • Proportional Hazards Models
  • Risk Factors
  • Survival Rate
  • Time Factors
  • Treatment Outcome

Substances

  • Antineoplastic Agents