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J Surg Oncol. 2017 Nov;116(6):665-670. doi: 10.1002/jso.24721. Epub 2017 Jul 3.

Impact of neoadjuvant chemotherapy on surgical outcomes among patients with hormone receptor positive breast cancer.

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Department of Surgery, University of Michigan Health Systems, Ann Arbor, Michigan.



Pathologic complete response (pCR) after neoadjuvant chemotherapy (NACT) is a surrogate for outcome, but not necessarily conversion to BCT eligibility. We sought to examine the impact of NACT on surgical decision making among HR+ patients.


Our IRB-approved breast cancer database was queried for patients who underwent NACT, including the clinicopathologic data and surgeon's pre- and post-NACT assessment. Surgical conversion rate (SCR) was defined as patients ineligible for BCT prior to NACT, who were given the choice following NACT.


Among 289 patients, pCR rates were highest among patients with HER2-enriched subtype (60%) and lowest in patients with luminal A disease (4%). Overall, the BCT rate was 41%, while 28% opted for bilateral mastectomy across subtypes. Despite a low pCR, the SCR was still high (54%) among patients with the luminal A subtype.


Despite poor pCR rates, NACT still has potential to improve surgical outcomes among hormone receptor positive patients. The surgical conversion rate is a superior measure of the impact of NACT on surgical decision making than examining BCT rates.


breast conservation; luminal A; mastectomy; neoadjuvant chemotherapy

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