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Cancer. 2018 Jul 15;124(14):2923-2930. doi: 10.1002/cncr.31518. Epub 2018 May 3.

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.

Author information

1
Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden.
2
Comprehensive Breast Program, University of Florida Health Cancer Center-Orlando Health, Orlando, Florida.
3
Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
4
Department of Breast Surgery, St. Luke's International Hospital, Tokyo, Japan.
5
Department of Breast Surgery, Osaka International Cancer Institute, Osaka, Japan.
6
Department of Endocrine Surgery, Osaka International Cancer Institute, Osaka, Japan.
7
Department of Oral, Medical and Biotechnological Sciences, University G. D'Annunzio, Chieti-Pescara, Italy.
8
Department of Surgery, Breast Health Center, Medical University Vienna, Vienna, Austria.
9
Breast Surgical Oncology, Breast Cancer Center, University Hospital VAll d'Hebron, Barcelona, Spain.
10
Breast Disease Division, Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil.
11
Department of Surgery, Chung-Ang University Hospital, Seoul, South Korea.
12
National Surgical Adjuvant Breast and Bowel Project Biostatistical Center, Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
13
Department of Breast Oncology, NHO Shikoku Cancer Center, Matsuyama, Japan.
14
Centre for Clinical Research, Vastmanlands County Hospital, Vasteras, Sweden.

Abstract

BACKGROUND:

Several studies have reported a high risk of local disease recurrence (LR) and locoregional disease recurrence (LRR) in patients with breast cancer after neoadjuvant chemotherapy (NCT) and breast-conserving therapy (BCT). The objective of the current study was to identify potential risk factors for LR and LRR after NCT and BCT.

METHODS:

Individual patient data sets from 9 studies were pooled. The outcomes of interest were the occurrence of LR and/or LRR. A 1-stage meta-analytic approach was used. Cox proportional hazards regression models were applied to identify factors that were predictive of LR and LRR, respectively.

RESULTS:

A total of 9 studies (4125 patients) provided their data sets. The 10-year LR rate was 6.5%, whereas the 10-year LRR rate was 10.3%. Four factors were found to be associated with a higher risk of LR: 1) estrogen receptor-negative disease; 2) cN + disease; 3) a lack of pathologic complete response in axilla (pN0); and 4) pN2 to pN3 disease. The predictive score for LR determined 3 risk groups: a low-risk, intermediate-risk, and high-risk group with 10-year LR rates of 4.0%, 7.9%, and 20.4%, respectively. Two additional factors were found to be associated with an increased risk of LRR: cT3 to cT4 disease and a lack of pathologic complete response in the breast. The predictive score for LRR determined 3 risk groups; a low-risk, intermediate-risk, and high-risk group with 10-year LRR rates of 3.2%, 10.1%, and 24.1%, respectively.

CONCLUSIONS:

BCT after NCT appears to be an oncologically safe procedure for a large percentage of patients with breast cancer. Two easy-to-use clinical scores were developed that can help clinicians to identify patients at higher risk of LR and LRR after NCT and BCT and individualize the postoperative treatment plan and follow-up. Cancer 2018;124:2923-30. © 2018 American Cancer Society.

KEYWORDS:

breast cancer; breast-conserving therapy; individual patient meta-analysis; locoregional disease recurrence; neoadjuvant

PMID:
29723396
DOI:
10.1002/cncr.31518
[Indexed for MEDLINE]
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