How Often Does Modern Neoadjuvant Chemotherapy Downstage Patients to Breast-Conserving Surgery?

Annals of Surgical Oncology
Oriana A PetruoloAndrea V Barrio

Abstract

Neoadjuvant chemotherapy (NAC) has been proven to increase breast-conserving surgery (BCS) rates, but data are limited on conversion rates from BCS-ineligible (BCSi) to BCS-eligible (BCSe), specifically, in patients with large tumors. Consecutive patients with stage I-III breast cancer treated with NAC from November 2013 to March 2019 were identified. BCS eligibility before and after NAC was prospectively determined. Patients deemed BCSi before NAC due to large tumor size were studied. Statistical analyses were conducted using Student's t-test, Wilcoxon rank sum test, Chi-square test, Fisher's test, and logistic regression. In this study, 600 of 1353 cancers were BCSi with large tumors; 69% were non-BCS candidates, 31% were borderline-BCS (bBCS) candidates. Of non-BCS candidates, 69% became BCSe after NAC; 66% chose BCS, and 90% were successful. Among bBCS candidates, 87% were BCSe after NAC, 73% chose BCS, and 96% were successful. On univariate analysis, bBCS candidacy, lower cT stage, cN0 status, absence of calcifications, human epidermal growth factor receptor 2 positive (HER2+)/triple negative (TN) receptor status, poor differentiation, ductal histology, and breast pCR were associated with conversion to BCS eligibility. On ...Continue Reading

References

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Nov 16, 2001·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·J A van der HageL Duchateau
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Feb 9, 2008·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Priya RastogiNorman Wolmark
Nov 17, 2019·Annals of Surgical Oncology·Nicole ChristianMary L Gemignani

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Citations

Dec 22, 2020·Minerva chirurgica·Giacomo MontagnaNicola Rocco

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