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Breast surgery after neoadjuvant chemotherapy in patients with lobular carcinoma: surgical and oncologic outcome

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Abstract

Introduction

Breast cancer patients with invasive lobular carcinoma (ILC) have an increased risk of positive margins after surgery and often show little response to neoadjuvant chemotherapy (NAC). We aimed to investigate surgical outcomes in patients with ILC treated with NAC.

Methods

In this retrospective cohort study, all breast cancer patients with ILC treated with NAC who underwent surgery at the Netherlands Cancer Institute from 2010 to 2019 were selected. Patients with mixed type ILC in pre-NAC biopsies were excluded if the lobular component was not confirmed in the surgical specimen. Main outcomes were tumor-positive margins and re-excision rate. Associations between baseline characteristics and tumor-positive margins were assessed, as were complications, locoregional recurrence rate (LRR), recurrence-free survival (RFS), and overall survival (OS).

Results

We included 191 patients. After NAC, 107 (56%) patients had breast conserving surgery (BCS) and 84 (44%) patients underwent mastectomy. Tumor-positive margins were observed in 67 (35%) patients. Fifty five (51%) had BCS and 12 (14%) underwent mastectomy (p value < 0.001). Re-excision was performed in 35 (33%) patients with BCS and in 4 (5%) patients with mastectomy. Definitive surgery was mastectomy in 107 (56%) patients and BCS in 84 (44%) patients. Tumor-positive margins were associated with cT ≥ 3 status (OR 4.62, 95% CI 1.26–16.98, p value 0.021) in the BCS group. Five-year LRR (4.7%), RFS (81%), and OS (93%) were not affected by type of surgery after NAC.

Conclusion

Although 33% of ILC breast cancer patients undergoing BCS after NAC required re-excision for positive resection margins, it is considered safe given that five-year RFS remained excellent and LRR and OS did not differ by extent of surgery.

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Data availability

The data that support the findings of this study are available from the corresponding author, IVDP, upon reasonable request.

Abbreviations

ALND:

Axillary lymph node dissection

BCS:

Breast conserving surgery

BCT:

Breast conserving therapy

CI:

Confidence interval

DCIS:

Ductal carcinoma in situ

HER2:

Human Epidermal growth factor Receptor 2

HR:

Hormone receptor

ILC:

Invasive lobular carcinoma

LCIS:

Lobular carcinoma in situ

LRR:

Locoregional recurrence rate

MARI:

Marked axillary lymph node

MRI:

Magnetic resonance imaging

NKI-AVL:

Netherlands Cancer Institute-Antoni van Leeuwenhoek

NAC:

Neoadjuvant chemotherapy

OR:

Odds ratio

OS:

Overall survival

pCR:

Pathologic complete response

rCR:

Radiologic complete response

RFS:

Recurrence free survival

rPR:

Radiologic partial response

TN:

Triple negative

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Surgical Oncology, Netherlands Cancer Institute–Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands

    Annemiek van Hemert, Ariane A. van Loevezijn, Anne Bosman, Marie-Jeanne T. F. D. Vrancken Peeters, Frederieke H. van Duijnhoven & Iris M. C. van der Ploeg

  2. Department of Surgery, NoordWest Ziekenhuisgroep, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands

    Anne Bosman

  3. Department of Pathology, Netherlands Cancer Institute – Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands

    Carmen A. Vlahu

  4. Department of Radiology, Netherlands Cancer Institute – Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands

    Claudette E. Loo

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  1. Annemiek van Hemert
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by AKEvanH and AAvanL. The first draft of the manuscript was written by AKEvanH and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Iris M. C. van der Ploeg.

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The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This study was approved by the institutional review board of the Netherlands Cancer Institute.

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Informed consent was obtained from all individual participants by ‘general hospital informed consent’ from all individual participants included in the study.

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van Hemert, A., van Loevezijn, A.A., Bosman, A. et al. Breast surgery after neoadjuvant chemotherapy in patients with lobular carcinoma: surgical and oncologic outcome. Breast Cancer Res Treat 204, 497–507 (2024). https://doi.org/10.1007/s10549-023-07192-8

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