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Breast Conservation Surgery and Mastectomy Have Similar Locoregional Recurrence After Neoadjuvant Chemotherapy: Results From 1462 Patients on the Prospective, Randomized I-SPY2 Trial.

Publication ,  Journal Article
Mukhtar, RA; Chau, H; Woriax, H; Piltin, M; Ahrendt, G; Tchou, J; Yu, H; Ding, Q; Dugan, CL; Sheade, J; Crown, A; Carr, M; Wong, J; Son, J ...
Published in: Ann Surg
September 1, 2023

Neoadjuvant chemotherapy (NAC) increases rates of successful breast-conserving surgery (BCS) in patients with breast cancer. However, some studies suggest that BCS after NAC may confer an increased risk of locoregional recurrence (LRR). We assessed LRR rates and locoregional recurrence-free survival (LRFS) in patients enrolled on I-SPY2 (NCT01042379), a prospective NAC trial for patients with clinical stage II to III, molecularly high-risk breast cancer. Cox proportional hazards models were used to evaluate associations between surgical procedure (BCS vs mastectomy) and LRFS adjusted for age, tumor receptor subtype, clinical T category, clinical nodal status, and residual cancer burden (RCB). In 1462 patients, surgical procedure was not associated with LRR or LRFS on either univariate or multivariate analysis. The unadjusted incidence of LRR was 5.4% after BCS and 7.0% after mastectomy, at a median follow-up time of 3.5 years. The strongest predictor of LRR was RCB class, with each increasing RCB class having a significantly higher hazard ratio for LRR compared with RCB 0 on multivariate analysis. Triple-negative receptor subtype was also associated with an increased risk of LRR (hazard ratio: 2.91, 95% CI: 1.8-4.6, P < 0.0001), regardless of the type of operation. In this large multi-institutional prospective trial of patients completing NAC, we found no increased risk of LRR or differences in LRFS after BCS compared with mastectomy. Tumor receptor subtype and extent of residual disease after NAC were significantly associated with recurrence. These data demonstrate that BCS can be an excellent surgical option after NAC for appropriately selected patients.

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Published In

Ann Surg

DOI

EISSN

1528-1140

Publication Date

September 1, 2023

Volume

278

Issue

3

Start / End Page

320 / 327

Location

United States

Related Subject Headings

  • Surgery
  • Retrospective Studies
  • Prospective Studies
  • Neoplasm Recurrence, Local
  • Neoadjuvant Therapy
  • Mastectomy, Segmental
  • Mastectomy
  • Humans
  • Female
  • Chemotherapy, Adjuvant
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Mukhtar, R. A., Chau, H., Woriax, H., Piltin, M., Ahrendt, G., Tchou, J., … ISPY-2 Locoregional Working Group, . (2023). Breast Conservation Surgery and Mastectomy Have Similar Locoregional Recurrence After Neoadjuvant Chemotherapy: Results From 1462 Patients on the Prospective, Randomized I-SPY2 Trial. Ann Surg, 278(3), 320–327. https://doi.org/10.1097/SLA.0000000000005968
Mukhtar, Rita A., Harrison Chau, Hannah Woriax, Mara Piltin, Gretchen Ahrendt, Julia Tchou, Hongmei Yu, et al. “Breast Conservation Surgery and Mastectomy Have Similar Locoregional Recurrence After Neoadjuvant Chemotherapy: Results From 1462 Patients on the Prospective, Randomized I-SPY2 Trial.Ann Surg 278, no. 3 (September 1, 2023): 320–27. https://doi.org/10.1097/SLA.0000000000005968.
Mukhtar, Rita A., et al. “Breast Conservation Surgery and Mastectomy Have Similar Locoregional Recurrence After Neoadjuvant Chemotherapy: Results From 1462 Patients on the Prospective, Randomized I-SPY2 Trial.Ann Surg, vol. 278, no. 3, Sept. 2023, pp. 320–27. Pubmed, doi:10.1097/SLA.0000000000005968.
Mukhtar RA, Chau H, Woriax H, Piltin M, Ahrendt G, Tchou J, Yu H, Ding Q, Dugan CL, Sheade J, Crown A, Carr M, Wong J, Son J, Yang R, Chan T, Terando A, Alvarado M, Ewing C, Tonneson J, Tamirisa N, Gould R, Singh P, Godellas C, Larson K, Chiba A, Rao R, Sauder C, Postlewait L, Lee MC, Symmans WF, Esserman LJ, Boughey JC, ISPY-2 Locoregional Working Group. Breast Conservation Surgery and Mastectomy Have Similar Locoregional Recurrence After Neoadjuvant Chemotherapy: Results From 1462 Patients on the Prospective, Randomized I-SPY2 Trial. Ann Surg. 2023 Sep 1;278(3):320–327.

Published In

Ann Surg

DOI

EISSN

1528-1140

Publication Date

September 1, 2023

Volume

278

Issue

3

Start / End Page

320 / 327

Location

United States

Related Subject Headings

  • Surgery
  • Retrospective Studies
  • Prospective Studies
  • Neoplasm Recurrence, Local
  • Neoadjuvant Therapy
  • Mastectomy, Segmental
  • Mastectomy
  • Humans
  • Female
  • Chemotherapy, Adjuvant