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Risk factors for locoregional disease recurrence after breast‐conserving therapy in patients with breast cancer treated with neoadjuvant chemotherapy: An international collaboration and individual patient meta‐analysis
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
Univ Florida, Hlth Canc Ctr Orlando Hlth, Comprehens Breast Program, Orlando, FL USA.
Univ Texas MD Anderson Canc Ctr, Dept Breast Surg Oncol, Houston, TX 77030 USA.
St Lukes Int Hosp, Dept Breast Surg, Tokyo, Japan.
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2018 (English)In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 124, no 14, p. 2923-2930Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Several studies have reported a high risk of local disease recurrence (LR) and locoregional disease recurrence (LRR) in patients with breast cancer after neoadjuvant chemotherapy (NCT) and breast-conserving therapy (BCT). The objective of the current study was to identify potential risk factors for LR and LRR after NCT and BCT. METHODS: Individual patient data sets from 9 studies were pooled. The outcomes of interest were the occurrence of LR and/or LRR. A 1-stage meta-analytic approach was used. Cox proportional hazards regression models were applied to identify factors that were predictive of LR and LRR, respectively. RESULTS: A total of 9 studies (4125 patients) provided their data sets. The 10-year LR rate was 6.5%, whereas the 10-year LRR rate was 10.3%. Four factors were found to be associated with a higher risk of LR: 1) estrogen receptor-negative disease; 2) cN+disease; 3) a lack of pathologic complete response in axilla (pN0); and 4) pN2 to pN3 disease. The predictive score for LR determined 3 risk groups: a low-risk, intermediate-risk, and high-risk group with 10-year LR rates of 4.0%, 7.9%, and 20.4%, respectively. Two additional factors were found to be associated with an increased risk of LRR: cT3 to cT4 disease and a lack of pathologic complete response in the breast. The predictive score for LRR determined 3 risk groups; a low-risk, intermediate-risk, and high-risk group with 10-year LRR rates of 3.2%, 10.1%, and 24.1%, respectively. CONCLUSIONS: BCT after NCT appears to be an oncologically safe procedure for a large percentage of patients with breast cancer. Two easy-to-use clinical scores were developed that can help clinicians to identify patients at higher risk of LR and LRR after NCT and BCT and individualize the postoperative treatment plan and follow-up.

Place, publisher, year, edition, pages
WILEY , 2018. Vol. 124, no 14, p. 2923-2930
Keywords [en]
breast cancer, breast-conserving therapy, individual patient meta-analysis, locoregional disease recurrence, neoadjuvant
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:uu:diva-361268DOI: 10.1002/cncr.31518ISI: 000437671900010PubMedID: 29723396OAI: oai:DiVA.org:uu-361268DiVA, id: diva2:1255087
Available from: 2018-10-11 Created: 2018-10-11 Last updated: 2019-01-31Bibliographically approved

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Valachis, Antonis

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