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Background: Few studies have evaluated the impact of the time interval between neoadjuvant chemotherapy (NAC) and surgery in breast cancer. In Latin America, where the vast majority of hospitals are oversaturated, it is important to define which patients to give priority and to be clear about ideal time or maximum to schedule surgery after NAC without altering the prognosis. The objective of this work is to establish the ideal time interval for post-neoadjuvant surgery and evaluate the impact on patient survival. Methods: We reviewed the clinical histories of breast cancer with clinical stage II and III who received NAC between 2005 and 2014. Patients were divided into 3 groups according to the time interval to surgery: <4, 4-8 and >8 weeks. Overall survival (OS) and recurrence-free survival (RFS) were estimated using the Kaplan-Meier method, and comparisons of survival curves using the logrank or Breslow test, both globally and by molecular subtypes. The optimal time to surgery has been determined by the Cox model. Results: During the study period, 583 patients who had post NA surgery before six months were registered. The median age was 49 years (range: 24-85), 82% had clinical stage III, 53% histological grade III, 32.7% were luminal A, 15.6% luminal B, 24.4% Her2 and 27.3% TN. According to the time interval to surgery, 67 (11.5%) patients had surgery before 4 weeks, 204 (35.0%) between 4 to 8 weeks, and 312 (53.5%) after 8 weeks. The groups do not present differences in relation to the clinical characteristics (p> 0.05). The median follow-up time was 4.8 years. The 5-year OS rate according to the time interval was 57.9, 61.5, and 62.7% (p = 0.581) and the RFS rate was 40.6, 52.3, and 51.1% (p = 0.411). No differences were found in the survival curves by molecular subtypes , except for luminal b like . In the multivariate analysis, the effect of the time interval to surgery was not significant in OS and RFS; however, the HR curve suggests that the appropriate cut-off point for surgical time would be 8 weeks. Table 1:Time Interval :OS - RFS  RFS  OS  MEDIAN5 - yearsPMEDIAN5 - yearsPWeeks for NAC to Surgery      <4 weeks3.240.6 6.157.9 4-8 weeks6.352.3 9.161.5 >8 weeks5.151.10.416.762.70.581       Weeks for NAC to Surgery      <8 weeks549.5 9.160.7 >8 weeks5.151.10.5856.762.70.414 Table 2 :Time Interval - Molecular Subtype  RFS  OS  MEDIAN5 - yearsPMEDIAN5 - yearsPLUMINAL A LIKE      < 8 weeks----74.1 ----84 >8 weeks7.163.80.719.973.90.236       *LUMINAL B LIKE      < 8 weeks2.336.8 5.460.5 >8 weeks5.857.60.46----820.08       HER2      <8 weeks2.228.7 3.938.4 >8weeks3.645.90.57.26.261.30.616       TRIPLE NEGATIVE      <8 weeks3.144.2 3.448.4 >8 weeks2.041.80.9143.743.90.516* ER + PR >20% KI67>14% , HER2 NEGATIVE Conclusion: The time interval between the end of neoadjuvant period and surgery has no impact on recurrence-free survival or on overall survival, despite this we suggest that the period of time between neoadjuvant and surgery not be greater than 8 weeks. More studies will be required to determine the ideal time interval and which cases should be prioritized according to the characteristics of our patients. Citation Format: Rebaza LP, Galarreta JA, Castañeda C, Cotrina JM, Vilchez S, de la Cruz M, Ponce J, Aguilar A, Flores C, Castillo M, Galvez M, Vigil C. Impact of the time interval between neoadjuvant chemotherapy and surgery in Latin-Americans breast cancer patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-14-12.

Objective: We evaluated breast cancer immunophenotype and variables measured at CNS-relapse as prognostic factors in a cohort of Hispanic patients. Methods: We reviewed data from 2602 breast cancer women in stages I-III diagnosed between 2000 and 2005 at the Instituto Nacional de Enfermedades Neoplásicas, Lima, Perú. According to immunophenotype, tumors were categorized in luminal A (RE+ and/or RP+, HER2−), luminal B (RE+ and/or RP+, HER2+), HER2 (RE−, RP−, HER2+) and triple negative (RE−, RP−, HER2−). Clinicopathological data at diagnosis and at CNS relapse were evaluated and used to calculate prognostic scores according to Recursive Partitioning Analysis (RPA) score, Graded Prognostic Assessment (GPA) Score, and Basic Score for Brain Metastases. Endpoints were time to CNS metastasis and Post CNS-relapse survival. Results: With a median follow-up of 7.5 years, 818 (31.4%) patients had locoregional or distant recurrence. In total, 159 (6.1%) patients developed CNS metastases, of whom 92 (3.5%) as the first site of recurrence and 22 meningeal metastases were detected. In triple negative, 51 (32.1%) developed SNC metastases, 46 (28.9%) in luminal A, 37 (23.3%) in HER2 and 25 (15.7%) in luminal B patients. Median time since breast cancer diagnosis to SNC metastases was 28.1 months (mo) and the variables influencing it were Clinical T (P < 0.001), clinical stage (P < 0.001), histologic grade (p = 0.005), estrogen and progesterone receptors ((p = 0.026 for both) and inmmunophenotype (P < 0.005). None of these factors was associated with post SNC-recurrence survival. In regard to variables measured at SNC relapse, we couldn't find differences in age groups (<65 vs ≥65 years old; p = 0.662), extracraneal metastases (present, 4.2mo vs absent, 5.3mo), number of brain metastases (<1 vs ≥ 2; p = 0.550) or volume of CNS metastases (<3cm; 7.7mo vs ≥3cm, 5.2mo; p = 0.298). Statistical differences were observed when patients were stratified by control of primary tumor (controlled, 6.3mo; vs uncontrolled, 3.6 mo; P < 0.001), leptomeningeal involvement (present, 3.0mo vs absent, 5.2mo; p = 0.25) and karnofski performance status (≥ 7, 6.5mo vs <7, 3.5mo; p = 0.002). In the multivariate analysis, significant variables related with a shorter post-SNC recurrence survival were a Karnofski performance status <7 (HR 1.46; p = 0.048); uncontrolled primary tumor (HR 1.92; p = 0.001); and leptomeningeal involvement (HR 1.94; p = 0.025). When survival was evaluated stratifying patients according to prognostic scores, we found differences when cases were grouped according to RPA score (Class I, 6.8 mo vs Class II, 5.5 mo vs Class III, 3.5 mo; p = 0.014). GPA scores could not identify groups with significant difference (p = 0.070). The basic score for BM detected groups with significant differences (scores 0–1, 3.7 mo vs score 2, 6.9 mo vs score 3, 6.8 mo). Conclusions: Prognostic scores calculated from variables measured at CNS relapse are useful to identify groups with shorter post CNS recurrence survival while immunophenotype of breast cancer was unable to identify groups of different prognosis. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-07-20.

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