Locally advanced breast cancer: breast-conserving surgery and other factors linked to overall survival after neoadjuvant treatment
BackgroundRecent data suggest that breast-conserving surgery (BCS) may positively impact overall survival (OS) in early breast cancer. However, the role of BCS in locally advanced breast cancer (LABC) following neoadjuvant therapy (NAT) remains uncertain.MethodsWe conducted a retrospective cohort st...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-11-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2023.1293288/full |
| _version_ | 1797635720902344704 |
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| author | Gabriela Bezerra Nobrega Gabriela Bezerra Nobrega Bruna Salani Mota Bruna Salani Mota Gabriela Boufelli de Freitas Gabriela Boufelli de Freitas Jonathan Yugo Maesaka Jonathan Yugo Maesaka Rosa Maria Salani Mota Rodrigo Goncalves Rodrigo Goncalves Angela Francisca Trinconi Angela Francisca Trinconi Marcos Desidério Ricci Marcos Desidério Ricci José Roberto Piato José Roberto Piato José Maria Soares-Jr Edmund Chada Baracat José Roberto Filassi José Roberto Filassi |
| author_facet | Gabriela Bezerra Nobrega Gabriela Bezerra Nobrega Bruna Salani Mota Bruna Salani Mota Gabriela Boufelli de Freitas Gabriela Boufelli de Freitas Jonathan Yugo Maesaka Jonathan Yugo Maesaka Rosa Maria Salani Mota Rodrigo Goncalves Rodrigo Goncalves Angela Francisca Trinconi Angela Francisca Trinconi Marcos Desidério Ricci Marcos Desidério Ricci José Roberto Piato José Roberto Piato José Maria Soares-Jr Edmund Chada Baracat José Roberto Filassi José Roberto Filassi |
| author_sort | Gabriela Bezerra Nobrega |
| collection | DOAJ |
| description | BackgroundRecent data suggest that breast-conserving surgery (BCS) may positively impact overall survival (OS) in early breast cancer. However, the role of BCS in locally advanced breast cancer (LABC) following neoadjuvant therapy (NAT) remains uncertain.MethodsWe conducted a retrospective cohort study involving 530 LABC patients who underwent surgery after NAT between 2010 and 2015. Outcomes examined included OS, distant recurrence rates (DRR), and loco-regional recurrence rates (LRRs).ResultsAmong the 927 breast cancer patients who received NAT, 530 were eligible for our study. Of these, 24.6% underwent BCS, while 75.4% underwent mastectomy (MS). The median follow-up duration was 79 months. BCS patients exhibited a higher pathological complete response (PCR) rate compared to those who underwent MS (22.3% vs. 10%, p < 0.001). The 6-year OS rates for BCS and MS were 81.5% and 62%, respectively (p < 0.000). In multivariate OS analysis, MS was associated with worse outcomes (OR 1.678; 95% CI 1.069–2.635; p = 0.024), as was body mass index (BMI) (OR 1.031; 95% CI 1.006–1.058; p = 0.017), and stage IIIB or IIIC (OR 2.450; 95% CI 1.561–3.846; p < 0.000). Conversely, PCR (OR 0.42; 95% CI 0.220–0.801; p = 0.008) was associated with improved survival. DRR was significantly lower in BCS (15.4%) compared to MS (36.8%) (OR 0.298; 95% CI 0.177–0.504). LRRs were comparable between BCS (9.2%) and MS (9.5%) (OR 0.693; 95% CI 0.347–1.383).ConclusionOur findings suggest that BCS is oncologically safe, even for patients with large lesions, and is associated with superior OS rates compared to MS. Additionally, lower BMI, lower pretreatment stage, and achieving PCR were associated with improved survival outcomes. |
| first_indexed | 2024-03-11T12:24:26Z |
| format | Article |
| id | doaj.art-2356799665c442839a5be9476e7a357b |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-03-11T12:24:26Z |
| publishDate | 2023-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-2356799665c442839a5be9476e7a357b2023-11-06T10:22:07ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2023-11-011310.3389/fonc.2023.12932881293288Locally advanced breast cancer: breast-conserving surgery and other factors linked to overall survival after neoadjuvant treatmentGabriela Bezerra Nobrega0Gabriela Bezerra Nobrega1Bruna Salani Mota2Bruna Salani Mota3Gabriela Boufelli de Freitas4Gabriela Boufelli de Freitas5Jonathan Yugo Maesaka6Jonathan Yugo Maesaka7Rosa Maria Salani Mota8Rodrigo Goncalves9Rodrigo Goncalves10Angela Francisca Trinconi11Angela Francisca Trinconi12Marcos Desidério Ricci13Marcos Desidério Ricci14José Roberto Piato15José Roberto Piato16José Maria Soares-Jr17Edmund Chada Baracat18José Roberto Filassi19José Roberto Filassi20Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BrazilSetor de Mastologia, Divisão de Ginecologia, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BrazilDisciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BrazilSetor de Mastologia, Divisão de Ginecologia, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BrazilDisciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BrazilSetor de Mastologia, Divisão de Ginecologia, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BrazilDisciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BrazilSetor de Mastologia, Divisão de Ginecologia, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BrazilDepartamento de Estatística e Matemática Aplicada, Universidade Federal do Ceará, Fortaleza, BrazilDisciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BrazilSetor de Mastologia, Divisão de Ginecologia, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BrazilDisciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BrazilSetor de Mastologia, Divisão de Ginecologia, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BrazilDisciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BrazilSetor de Mastologia, Divisão de Ginecologia, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BrazilDisciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BrazilSetor de Mastologia, Divisão de Ginecologia, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BrazilDisciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BrazilDisciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BrazilDisciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BrazilSetor de Mastologia, Divisão de Ginecologia, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BrazilBackgroundRecent data suggest that breast-conserving surgery (BCS) may positively impact overall survival (OS) in early breast cancer. However, the role of BCS in locally advanced breast cancer (LABC) following neoadjuvant therapy (NAT) remains uncertain.MethodsWe conducted a retrospective cohort study involving 530 LABC patients who underwent surgery after NAT between 2010 and 2015. Outcomes examined included OS, distant recurrence rates (DRR), and loco-regional recurrence rates (LRRs).ResultsAmong the 927 breast cancer patients who received NAT, 530 were eligible for our study. Of these, 24.6% underwent BCS, while 75.4% underwent mastectomy (MS). The median follow-up duration was 79 months. BCS patients exhibited a higher pathological complete response (PCR) rate compared to those who underwent MS (22.3% vs. 10%, p < 0.001). The 6-year OS rates for BCS and MS were 81.5% and 62%, respectively (p < 0.000). In multivariate OS analysis, MS was associated with worse outcomes (OR 1.678; 95% CI 1.069–2.635; p = 0.024), as was body mass index (BMI) (OR 1.031; 95% CI 1.006–1.058; p = 0.017), and stage IIIB or IIIC (OR 2.450; 95% CI 1.561–3.846; p < 0.000). Conversely, PCR (OR 0.42; 95% CI 0.220–0.801; p = 0.008) was associated with improved survival. DRR was significantly lower in BCS (15.4%) compared to MS (36.8%) (OR 0.298; 95% CI 0.177–0.504). LRRs were comparable between BCS (9.2%) and MS (9.5%) (OR 0.693; 95% CI 0.347–1.383).ConclusionOur findings suggest that BCS is oncologically safe, even for patients with large lesions, and is associated with superior OS rates compared to MS. Additionally, lower BMI, lower pretreatment stage, and achieving PCR were associated with improved survival outcomes.https://www.frontiersin.org/articles/10.3389/fonc.2023.1293288/fullbreast neoplasmsneoadjuvant therapylocal diseasesegmental mastectomybreast-conserving surgerysurvival rate |
| spellingShingle | Gabriela Bezerra Nobrega Gabriela Bezerra Nobrega Bruna Salani Mota Bruna Salani Mota Gabriela Boufelli de Freitas Gabriela Boufelli de Freitas Jonathan Yugo Maesaka Jonathan Yugo Maesaka Rosa Maria Salani Mota Rodrigo Goncalves Rodrigo Goncalves Angela Francisca Trinconi Angela Francisca Trinconi Marcos Desidério Ricci Marcos Desidério Ricci José Roberto Piato José Roberto Piato José Maria Soares-Jr Edmund Chada Baracat José Roberto Filassi José Roberto Filassi Locally advanced breast cancer: breast-conserving surgery and other factors linked to overall survival after neoadjuvant treatment Frontiers in Oncology breast neoplasms neoadjuvant therapy local disease segmental mastectomy breast-conserving surgery survival rate |
| title | Locally advanced breast cancer: breast-conserving surgery and other factors linked to overall survival after neoadjuvant treatment |
| title_full | Locally advanced breast cancer: breast-conserving surgery and other factors linked to overall survival after neoadjuvant treatment |
| title_fullStr | Locally advanced breast cancer: breast-conserving surgery and other factors linked to overall survival after neoadjuvant treatment |
| title_full_unstemmed | Locally advanced breast cancer: breast-conserving surgery and other factors linked to overall survival after neoadjuvant treatment |
| title_short | Locally advanced breast cancer: breast-conserving surgery and other factors linked to overall survival after neoadjuvant treatment |
| title_sort | locally advanced breast cancer breast conserving surgery and other factors linked to overall survival after neoadjuvant treatment |
| topic | breast neoplasms neoadjuvant therapy local disease segmental mastectomy breast-conserving surgery survival rate |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2023.1293288/full |
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