Annals of Surgical Oncology

, Volume 22, Issue 1, pp 75–81 | Cite as

Surgical Patterns of Care in Patients with Invasive Breast Cancer Treated with Neoadjuvant Systemic Therapy and Breast Magnetic Resonance Imaging: Results of a Secondary Analysis of TBCRC 017

  • Kandace P. McGuire
  • E. Shelley Hwang
  • Alan Cantor
  • Mehra Golshan
  • Funda Meric-Bernstam
  • Janet K. Horton
  • Rita Nanda
  • Keith D. Amos
  • Andres Forero
  • Cliff A. Hudis
  • Ingrid Meszoely
  • Jennifer F. De Los Santos
Breast Oncology

Abstract

Background

Neoadjuvant chemotherapy (NCT) downstages advanced primary tumors, with magnetic resonance imaging (MRI) being the most sensitive imaging predictor of response. However, the impact of MRI evaluation on surgical treatment decisions in the neoadjuvant setting has not been well described. We report surgical patterns of care across 8 National Cancer Institute comprehensive cancer centers in women receiving both NCT and MRI to evaluate the impact of MRI findings on surgical planning.

Methods

Seven hundred seventy women from 8 institutions received NCT with MRI obtained both before and after systemic treatment. Univariate and multivariate analyses of imaging, patient-, and tumor-related covariates associated with choice of breast surgery were conducted.

Results

MRI and surgical data were available on 759 of 770 patients. A total of 345 of 759 (45 %) patients received breast-conserving surgery and 414 of 759 (55 %) received mastectomy. Mastectomy occurred more commonly in patients with incomplete MRI response versus complete (58 vs. 43 %) (p = 0.0003). On multivariate analysis, positive estrogen receptor status (p = 0.02), incomplete MRI response (p = 0.0003), higher baseline T classification (p < 0.0001), younger age (p < 0.0006), and institution (p = 0.003) were independent predictors of mastectomy. A statistically significant trend toward increasing use of mastectomy with increasing T stage at presentation (p < 0.0001) was observed in patients with incomplete response by MRI only. Among women with complete response on MRI, 43 % underwent mastectomy.

Conclusions

Within a multi-institutional cohort of women undergoing neoadjuvant treatment for breast cancer, MRI findings were not clearly associated with extent of surgery. This study shows that receptor status, T stage at diagnosis, young age, and treating institution are more significant determinants of surgical treatment choice than MRI response data.

Notes

Acknowledgments

We are grateful to all of the patients who were included in this study and to the Translational Breast Cancer Research Consortium investigators and data managers for their efforts. We are very appreciative of funding support from the Translational Breast Cancer Research Consortium from the AVON Foundation, the Breast Cancer Research Foundation, and Susan G. Komen for the Cure. We gratefully acknowledge the American College of Radiology Imaging Network (ACRIN) for granting permission to include patients who were treated on the ACRIN 6657/I-SPY Trial (supported by National Cancer Institute grants U01 CA079778 and U01 CA080098).

Disclosure

The authors declare no conflict of interest.

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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Kandace P. McGuire
    • 1
  • E. Shelley Hwang
    • 2
  • Alan Cantor
    • 3
  • Mehra Golshan
    • 4
  • Funda Meric-Bernstam
    • 5
  • Janet K. Horton
    • 6
  • Rita Nanda
    • 7
  • Keith D. Amos
    • 8
  • Andres Forero
    • 9
  • Cliff A. Hudis
    • 10
  • Ingrid Meszoely
    • 11
  • Jennifer F. De Los Santos
    • 12
  1. 1.Department of Surgery, Magee-Womens HospitalUniversity of PittsburghPittsburghUSA
  2. 2.Department of SurgeryDuke UniversityDurhamUSA
  3. 3.Division of Biostatistics/Preventive MedicineUniversity of Alabama at Birmingham Comprehensive Cancer CenterBirminghamUSA
  4. 4.Department of SurgeryBrigham and Women’s Hospital, Harvard Medical SchoolBostonUSA
  5. 5.Department of Surgical OncologyMD Anderson Cancer CenterHoustonUSA
  6. 6.Department of Radiation OncologyDuke UniversityDurhamUSA
  7. 7.Section of Hematology/OncologyUniversity of ChicagoChicagoUSA
  8. 8.Department of SurgeryUniversity of North CarolinaChapel HillUSA
  9. 9.Division of Hematology/Clinical OncologyUniversity of Alabama at Birmingham Comprehensive Cancer CenterBirminghamUSA
  10. 10.Breast Cancer Medicine ServiceMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  11. 11.Department of Surgical Oncology, The Vanderbilt Breast CenterVanderbilt Ingram Cancer CenterNashvilleUSA
  12. 12.Department of Radiation OncologyUniversity of Alabama at Birmingham Comprehensive Cancer CenterBirminghamUSA

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