Locoregional recurrence and survival of breast-conserving surgery compared to mastectomy following neoadjuvant chemotherapy in operable breast cancer

Fa-You Lv; Zongming Mo; Binjie Chen; Zhen Huang; Qinguo Mo; Qixing Tan

doi:10.3389/fonc.2024.1308343

Locoregional recurrence and survival of breast-conserving surgery compared to mastectomy following neoadjuvant chemotherapy in operable breast cancer

Front Oncol. 2024 Mar 28:14:1308343. doi: 10.3389/fonc.2024.1308343. eCollection 2024.

Authors

Fa-You Lv^#¹, Zongming Mo^#², Binjie Chen^#¹, Zhen Huang¹, Qinguo Mo¹, Qixing Tan¹

Affiliations

¹ Department of Breast Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China.
² Department of Breast Surgery, Guangxi Zhuang Autonomous Region People's Hospital, Nanning, Guangxi, China.

^# Contributed equally.

Abstract

Background: The risk of locoregional recurrence (LRR) and the long-term prognosis of breast-conserving surgery (BCS) after neoadjuvant chemotherapy (NAC) are still controversial. This study aimed to evaluate oncological outcomes for patients undergoing BCS after NAC and determine LRR and survival predictors.

Methods: This study was a retrospective cohort study of patients with locally advanced breast cancer (LABC) who received NAC and underwent BCS or mastectomy from June 2011 to November 2020. LRR, disease-free survival (DFS), and overall survival (OS) were compared in patients undergoing BCS or mastectomy. Univariate and multivariate analyses were performed to determine LRR, DFS, and OS predictors.

Results: A total of 585 patients were included, of whom 106 (18.1%) underwent BCS and 479 (81.9%) underwent a mastectomy. The LRR rate was 11.3% in the BCS group and 16.3% in the mastectomy group, revealing no significant difference(p = 0.200). In patients who underwent BCS, clinical lymph node status, histological grade and pathological complete response (pCR) were independent factors to predict LRR. There was no significant difference in DFS and OS between the BCS and the mastectomy groups. Multivariable analysis showed that lymph node status, histological grade, molecular subtypes, pCR and Miller&Payne (M&P) classification were independent predictors of DFS. Lymph node status, molecular subtypes and pCR were independent predictors of OS. BCS or mastectomy was not an independent predictor of DFS or OS.

Conclusion: Compared with mastectomy, BCS after NAC may not increase the risk of local recurrence or mortality, BCS can be performed in selected patients with small tumor size and good response to NAC.

Keywords: breast cancer; breast-conserving surgery; mastectomy; neoadjuvant chemotherapy; prognosis.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by the National Natural Science Foundation of China (NSFC; Grant No. 82160481), the Natural Science Foundation of Guangxi, China(Grant No. 2021GXNSFBA196015) and the Youth Program of Scientific Research Foundation of Guangxi Medical University Cancer Hospital (Grant No. 2021-05).