• Annals of surgery · Sep 2023

    Breast Conservation Surgery and Mastectomy have Similar Locoregional Recurrence Following Neoadjuvant Chemotherapy: Results from 1,462 Patients on the Prospective, Randomized I-SPY2 Trial.

    • Rita A Mukhtar, Harrison Chau, Hannah Woriax, Mara Piltin, Gretchen Ahrendt, Julia Tchou, Hongmei Yu, Qian Ding, Catherine Lu Dugan, Jori Sheade, Angelena Crown, Michael Carr, Jasmine Wong, Jennifer Son, Rachel Yang, Theresa Chan, Alicia Terando, Michael Alvarado, Cheryl Ewing, Jennifer Tonneson, Nina Tamirisa, Rebekah Gould, Puneet Singh, Constantine Godellas, Kelsey Larson, Akiko Chiba, Roshni Rao, Candice Sauder, Lauren Postlewait, Marie Catherine Lee, William Fraser Symmans, Laura J Esserman, Judy C Boughey, and ISPY-2 Locoregional Working Group.
    • Department of Surgery, University of California San Francisco, San Francisco, CA.
    • Ann. Surg. 2023 Sep 1; 278 (3): 320327320-327.

    AbstractNeoadjuvant 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.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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