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

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

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.

Methods

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.

Results

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 multivariable analysis, receptor status (hormone receptor positive [HR+]/HER2– ref; odds ratio [OR] HER2+ 1.63, P = 0.047; HR–/HER2– OR, 2.26, P = 0.003) and breast pCR (OR 2.62, P < 0.001) predicted successful downstaging, while larger clinical tumor size (OR 0.86, P = 0.003), non-BCS candidacy (OR 0.46, P = 0.003), cN+ status (OR 0.54, P = 0.008), and calcifications (OR 0.56, P = 0.007) predicted lower downstaging rates.

Conclusion

In patients with large tumors precluding BCS, conversion to BCS eligibility was high with NAC, particularly in bBCS candidates. HER2+/TN receptor status predicted successful downstaging, while lower downstaging rates were observed with larger tumors, cN+ status, and calcifications. These factors should be considered when selecting patients for NAC.

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Acknowledgments

The preparation of this manuscript was supported in part by NIH/NCI Cancer Center Support Grant No. P30 CA008748 to Memorial Sloan Kettering Cancer Center.

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Authors and Affiliations

  1. Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Oriana Petruolo MD, Giacomo Montagna MD, Tiana Le BS, Monica Morrow MD & Andrea V. Barrio MD

  2. Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Varadan Sevilimedu MBBS, DrPH

Authors
  1. Oriana Petruolo MD
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  2. Varadan Sevilimedu MBBS, DrPH
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  3. Giacomo Montagna MD
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  4. Tiana Le BS
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  5. Monica Morrow MD
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  6. Andrea V. Barrio MD
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Corresponding author

Correspondence to Andrea V. Barrio MD.

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Disclosure

Dr. Monica Morrow has received speaking honoraria from Genomic Health. Dr. Andrea V. Barrio has received speaking honoraria from Roche. Dr. Giacomo Montagna is supported by the Ticino Cancer League, the Hanne Liebermann Foundation, the Fondation Ancrage, and the HEMMI-Stiftung. The remaining authors have no conflicts of interest to disclose.

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Accepted for presentation in podium format at the Society of Surgical Oncology 2020 International Conference on Surgical Cancer Care.

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Petruolo, O., Sevilimedu, V., Montagna, G. et al. How Often Does Modern Neoadjuvant Chemotherapy Downstage Patients to Breast-Conserving Surgery?. Ann Surg Oncol 28, 287–294 (2021). https://doi.org/10.1245/s10434-020-08593-5

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  • DOI: https://doi.org/10.1245/s10434-020-08593-5

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