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A prospective cohort study identifying radiologic and tumor related factors of importance for breast conserving surgery after neoadjuvant chemotherapy

Gulis, K. LU orcid ; Ellbrant, J. LU ; Svensjö, T. LU ; Skarping, I. LU orcid ; Vallon-Christersson, J. LU orcid ; Loman, N. LU ; Bendahl, P. O. LU and Rydén, L. LU orcid (2023) In European Journal of Surgical Oncology 49(7). p.1189-1195
Abstract

Introduction: Neoadjuvant chemotherapy (NAC) is an established treatment option for early breast cancer, potentially downstaging the tumor and increasing the eligibility for breast-conserving surgery (BCS). The primary aim of this study was to assess the rate of BCS after NAC, and the secondary aim was to identify predictors of application of BCS after NAC. Materials and methods: This was an observational prospective cohort study of 226 patients in the SCAN-B (Clinical Trials NCT02306096) neoadjuvant cohort during 2014–2019. Eligibility for BCS was assessed at baseline and after NAC. Uni- and multivariable logistic regression analyses were performed using covariates with clinical relevance and/or those associated with outcome (BCS... (More)

Introduction: Neoadjuvant chemotherapy (NAC) is an established treatment option for early breast cancer, potentially downstaging the tumor and increasing the eligibility for breast-conserving surgery (BCS). The primary aim of this study was to assess the rate of BCS after NAC, and the secondary aim was to identify predictors of application of BCS after NAC. Materials and methods: This was an observational prospective cohort study of 226 patients in the SCAN-B (Clinical Trials NCT02306096) neoadjuvant cohort during 2014–2019. Eligibility for BCS was assessed at baseline and after NAC. Uni- and multivariable logistic regression analyses were performed using covariates with clinical relevance and/or those associated with outcome (BCS versus mastectomy), including tumor subtype, by gene expression analysis. Results: The overall BCS rate was 52%, and this rate increased during the study period (from 37% to 52%). Pathological complete response was achieved in 69 patients (30%). Predictors for BCS were smaller tumor size on mammography, visibility on ultrasound, histological subtype other than lobular, benign axillary status, and a diagnosis of triple-negative or HER2-positive subtype, with a similar trend for gene expression subtypes. Mammographic density was negatively related to BCS in a dose-response pattern. In the multivariable logistic regression model, tumor stage at diagnosis and mammographic density showed the strongest association with BCS. Conclusion: The rate of BCS after NAC increased during the study period to 52%. With modern treatment options for NAC the potential for tumor response and BCS eligibility might further increase.

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author
; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Breast cancer, Breast conserving surgery, Breast density, Molecular subtypes, Neoadjuvant treatment
in
European Journal of Surgical Oncology
volume
49
issue
7
pages
1189 - 1195
publisher
Elsevier
external identifiers
  • scopus:85151525923
  • pmid:37019807
ISSN
0748-7983
DOI
10.1016/j.ejso.2023.03.225
language
English
LU publication?
yes
id
a486f3bd-1d3d-4cab-a101-a9dd9847d306
date added to LUP
2023-05-23 15:03:19
date last changed
2024-04-19 22:09:27
@article{a486f3bd-1d3d-4cab-a101-a9dd9847d306,
  abstract     = {{<p>Introduction: Neoadjuvant chemotherapy (NAC) is an established treatment option for early breast cancer, potentially downstaging the tumor and increasing the eligibility for breast-conserving surgery (BCS). The primary aim of this study was to assess the rate of BCS after NAC, and the secondary aim was to identify predictors of application of BCS after NAC. Materials and methods: This was an observational prospective cohort study of 226 patients in the SCAN-B (Clinical Trials NCT02306096) neoadjuvant cohort during 2014–2019. Eligibility for BCS was assessed at baseline and after NAC. Uni- and multivariable logistic regression analyses were performed using covariates with clinical relevance and/or those associated with outcome (BCS versus mastectomy), including tumor subtype, by gene expression analysis. Results: The overall BCS rate was 52%, and this rate increased during the study period (from 37% to 52%). Pathological complete response was achieved in 69 patients (30%). Predictors for BCS were smaller tumor size on mammography, visibility on ultrasound, histological subtype other than lobular, benign axillary status, and a diagnosis of triple-negative or HER2-positive subtype, with a similar trend for gene expression subtypes. Mammographic density was negatively related to BCS in a dose-response pattern. In the multivariable logistic regression model, tumor stage at diagnosis and mammographic density showed the strongest association with BCS. Conclusion: The rate of BCS after NAC increased during the study period to 52%. With modern treatment options for NAC the potential for tumor response and BCS eligibility might further increase.</p>}},
  author       = {{Gulis, K. and Ellbrant, J. and Svensjö, T. and Skarping, I. and Vallon-Christersson, J. and Loman, N. and Bendahl, P. O. and Rydén, L.}},
  issn         = {{0748-7983}},
  keywords     = {{Breast cancer; Breast conserving surgery; Breast density; Molecular subtypes; Neoadjuvant treatment}},
  language     = {{eng}},
  number       = {{7}},
  pages        = {{1189--1195}},
  publisher    = {{Elsevier}},
  series       = {{European Journal of Surgical Oncology}},
  title        = {{A prospective cohort study identifying radiologic and tumor related factors of importance for breast conserving surgery after neoadjuvant chemotherapy}},
  url          = {{http://dx.doi.org/10.1016/j.ejso.2023.03.225}},
  doi          = {{10.1016/j.ejso.2023.03.225}},
  volume       = {{49}},
  year         = {{2023}},
}