Renee L Arlow1, Lisa E Paddock2, Xiaoling Niu3, Laurie Kirstein4, Bruce G Haffty5, Sharad Goyal5, Thomas Kearney6, Deborah Toppmeyer7, Antoinette M Stroup2, Atif J Khan5. 1. Department of Surgery, Division of Endocrine and Oncologic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA. 2. Department of Epidemiology, Rutgers School of Public Health and Rutgers Cancer Institute of New Jersey. 3. Cancer Epidemiology Services, New Jersey Department of Health, Trenton, NJ. 4. Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, NY. 5. Departments of Radiation Oncology. 6. Surgery, Division of Surgical Oncology. 7. Department of Internal Medicine, Section of Medical Oncology, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick.
Abstract
OBJECTIVES: Neoadjuvant chemotherapy can increase the rate of breast-conserving surgery by downstaging disease in patients with breast cancer. The aim of this study was to determine whether patients who received neoadjuvant chemotherapy have equal survival after breast-conservation therapy compared with mastectomy. MATERIAL AND METHODS: Using the New Jersey State Cancer Registry (NJSCR) patients with a primary breast cancer diagnosed between 1998 and 2003 who underwent neoadjuvant chemotherapy were selected (n=1,468). Of those, only patients who received lumpectomy plus radiation (n=276) or mastectomy without radiation (n=442) were included in the analysis. The main outcome measured included 10-year breast cancer-specific mortality, with 90% of patients with known vital status through the end of 2011. RESULTS: Baseline characteristics did not differ significantly between the breast-conservation and mastectomy without radiation groups except with respect to summary stage and lymph node involvement. After propensity score matching these differences were no longer statistically significant; however, both estrogen and progesterone status achieved statistical significance. The Kaplan-Meier survival curve showed that the breast-conservation group had significantly higher breast cancer-specific survival than the mastectomy group (P=0.0046). After adjusting for the propensity score in the regression model, the breast-conservation group continued to show significantly better survival than the mastectomy group (hazard ratios, 0.46; 95% confidence interval, 0.27-0.78). CONCLUSIONS: This study is consistent with previous research showing that breast-conserving surgery after neoadjuvant chemotherapy does not reduce breast cancer-specific survival. In fact, patients undergoing breast-conservation after neoadjuvant therapy appeared to have better survival than patients undergoing mastectomy without radiation.
OBJECTIVES: Neoadjuvant chemotherapy can increase the rate of breast-conserving surgery by downstaging disease in patients with breast cancer. The aim of this study was to determine whether patients who received neoadjuvant chemotherapy have equal survival after breast-conservation therapy compared with mastectomy. MATERIAL AND METHODS: Using the New Jersey State Cancer Registry (NJSCR) patients with a primary breast cancer diagnosed between 1998 and 2003 who underwent neoadjuvant chemotherapy were selected (n=1,468). Of those, only patients who received lumpectomy plus radiation (n=276) or mastectomy without radiation (n=442) were included in the analysis. The main outcome measured included 10-year breast cancer-specific mortality, with 90% of patients with known vital status through the end of 2011. RESULTS: Baseline characteristics did not differ significantly between the breast-conservation and mastectomy without radiation groups except with respect to summary stage and lymph node involvement. After propensity score matching these differences were no longer statistically significant; however, both estrogen and progesterone status achieved statistical significance. The Kaplan-Meier survival curve showed that the breast-conservation group had significantly higher breast cancer-specific survival than the mastectomy group (P=0.0046). After adjusting for the propensity score in the regression model, the breast-conservation group continued to show significantly better survival than the mastectomy group (hazard ratios, 0.46; 95% confidence interval, 0.27-0.78). CONCLUSIONS: This study is consistent with previous research showing that breast-conserving surgery after neoadjuvant chemotherapy does not reduce breast cancer-specific survival. In fact, patients undergoing breast-conservation after neoadjuvant therapy appeared to have better survival than patients undergoing mastectomy without radiation.
Authors: B Fisher; A Brown; E Mamounas; S Wieand; A Robidoux; R G Margolese; A B Cruz; E R Fisher; D L Wickerham; N Wolmark; A DeCillis; J L Hoehn; A W Lees; N V Dimitrov Journal: J Clin Oncol Date: 1997-07 Impact factor: 44.544
Authors: Philip M Poortmans; Sandra Collette; Carine Kirkove; Erik Van Limbergen; Volker Budach; Henk Struikmans; Laurence Collette; Alain Fourquet; Philippe Maingon; Mariacarla Valli; Karin De Winter; Simone Marnitz; Isabelle Barillot; Luciano Scandolaro; Ernest Vonk; Carla Rodenhuis; Hugo Marsiglia; Nicola Weidner; Geertjan van Tienhoven; Christoph Glanzmann; Abraham Kuten; Rodrigo Arriagada; Harry Bartelink; Walter Van den Bogaert Journal: N Engl J Med Date: 2015-07-23 Impact factor: 91.245
Authors: Allen M Chen; Funda Meric-Bernstam; Kelly K Hunt; Howard D Thames; Elesyia D Outlaw; Eric A Strom; Marsha D McNeese; Henry M Kuerer; Merrick I Ross; S Eva Singletary; Fredrick C Ames; Barry W Feig; Aysegul A Sahin; George H Perkins; Gildy Babiera; Gabriel N Hortobagyi; Thomas A Buchholz Journal: Cancer Date: 2005-02-15 Impact factor: 6.860
Authors: B Fisher; J Bryant; N Wolmark; E Mamounas; A Brown; E R Fisher; D L Wickerham; M Begovic; A DeCillis; A Robidoux; R G Margolese; A B Cruz; J L Hoehn; A W Lees; N V Dimitrov; H D Bear Journal: J Clin Oncol Date: 1998-08 Impact factor: 44.544
Authors: Priya Rastogi; Stewart J Anderson; Harry D Bear; Charles E Geyer; Morton S Kahlenberg; André Robidoux; Richard G Margolese; James L Hoehn; Victor G Vogel; Shaker R Dakhil; Deimante Tamkus; Karen M King; Eduardo R Pajon; Mary Johanna Wright; Jean Robert; Soonmyung Paik; Eleftherios P Mamounas; Norman Wolmark Journal: J Clin Oncol Date: 2008-02-10 Impact factor: 44.544
Authors: Gabriel De la Cruz Ku; Manish Karamchandani; Diego Chambergo-Michilot; Alexis R Narvaez-Rojas; Michael Jonczyk; Fortunato S Príncipe-Meneses; David Posawatz; Salvatore Nardello; Abhishek Chatterjee Journal: Ann Surg Oncol Date: 2022-07-25 Impact factor: 4.339
Authors: Janine M Simons; Julien G Jacobs; Joost P Roijers; Maarten A Beek; Leandra J M Boonman-de Winter; Arjen M Rijken; Paul D Gobardhan; Jan H Wijsman; Eric Tetteroo; Joan B Heijns; C Y Yick; Ernest J T Luiten Journal: Breast Cancer Res Treat Date: 2020-10-19 Impact factor: 4.872