Breast Conservation Surgery and Mastectomy Have Similar Locoregional Recurrence After Neoadjuvant Chemotherapy Results From 1462 Patients on the Prospective, Randomized I-SPY2 Trial

被引:14
作者
Mukhtar, Rita [1 ]
Chau, Harrison [2 ]
Woriax, Hannah [3 ]
Piltin, Mara [4 ]
Ahrendt, Gretchen [5 ]
Tchou, Julia [6 ]
Yu, Hongmei [7 ]
Ding, Qian [7 ]
Dugan, Catherine Lu [1 ]
Sheade, Jori [8 ]
Crown, Angelena [9 ]
Carr, Michael [10 ]
Wong, Jasmine [1 ]
Son, Jennifer
Yang, Rachel [1 ]
Chan, Theresa
Terando, Alicia
Alvarado, Michael [1 ]
Ewing, Cheryl [1 ]
Tonneson, Jennifer
Tamirisa, Nina
Gould, Rebekah
Singh, Puneet
Godellas, Constantine
Larson, Kelsey
Chiba, Akiko [3 ]
Rao, Roshni
Sauder, Candice
Postlewait, Lauren
Lee, Marie Catherine
Symmans, William Fraser J.
Esserman, Laura C. [1 ]
Boughey, Judy [4 ]
机构
[1] Univ Calif San Francisco, Dept Surg, San Francisco, CA 94122 USA
[2] Univ Calif San Diego, Dept Surg, San Diego, CA USA
[3] Duke Univ, Med Ctr, Dept Surg, Durham, NC USA
[4] Mayo Clin, Dept Surg, Rochester, MN USA
[5] Univ Colorado, Dept Surg, Aurora, CA USA
[6] Univ Penn, Dept Surg, Philadelphia, PA USA
[7] Quantum Leap Healthcare Collaborat, San Francisco, CA USA
[8] Northwestern Univ, Dept Surg, Chicago, IL USA
[9] Swedish Canc Inst, Dept Surg, Seattle, WA USA
[10] Univ Louisville, Dept Surg, Louisville, KY USA
基金
美国国家卫生研究院;
关键词
breast cancer; breast conservation; breast surgery; local recurrence; mastectomy; neoadjuvant chemotherapy; recurrence; response to therapy; surgery; tumor biology; PREOPERATIVE CHEMOTHERAPY; CANCER; SUBTYPE;
D O I
10.1097/SLA.0000000000005968
中图分类号
R61 [外科手术学];
学科分类号
摘要
Neoadjuvant chemotherapy (NAC) increases rates of successful breast-conserving surgery (BCS) in patients with breast cancer. However, some studies suggest that BCS after NAC may confer an increased risk of locoregional recurrence (LRR). We assessed LRR rates and locoregional recurrence-free survival (LRFS) in patients enrolled on I-SPY2 (NCT01042379), a prospective NAC trial for patients with clinical stage II to III, molecularly high-risk breast cancer. Cox proportional hazards models were used to evaluate associations between surgical procedure (BCS vs mastectomy) and LRFS adjusted for age, tumor receptor subtype, clinical T category, clinical nodal status, and residual cancer burden (RCB). In 1462 patients, surgical procedure was not associated with LRR or LRFS on either univariate or multivariate analysis. The unadjusted incidence of LRR was 5.4% after BCS and 7.0% after mastectomy, at a median follow-up time of 3.5 years. The strongest predictor of LRR was RCB class, with each increasing RCB class having a significantly higher hazard ratio for LRR compared with RCB 0 on multivariate analysis. Triple-negative receptor subtype was also associated with an increased risk of LRR (hazard ratio: 2.91, 95% CI: 1.8-4.6, P < 0.0001), regardless of the type of operation. In this large multi-institutional prospective trial of patients completing NAC, we found no increased risk of LRR or differences in LRFS after BCS compared with mastectomy. Tumor receptor subtype and extent of residual disease after NAC were significantly associated with recurrence. These data demonstrate that BCS can be an excellent surgical option after NAC for appropriately selected patients.
引用
收藏
页码:320 / 327
页数:8
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