Oncological outcome of complete response after neoadjuvant chemotherapy for breast conserving surgery: a systematic review and meta-analysis

Abstract

BackgroundWith limited sample sizes and single-institution designs, how complete response (CR) after neoadjuvant chemotherapy (NAC) influences breast conserving surgery (BCS) and its value in prognosis are not clear.MethodsA systematic research review was conducted using electronic database. The rate of clinical complete response (cCR) in BCS after NAC and these pathological CR (PCR) and non-pCR BCS patients’ local recurrence-free survival (LRFS), distance recurrence-free survival (DRFS), overall survival (OS), and disease-free survival (DFS) rates were collected. A pooled analysis was performed using a fixed or random effects model and a Q test to determine heterogeneity.ResultsSixteen studies with a total of 4639 patients were included. The pooled data revealed that cCR patients compared with non-cCR patients had significantly higher rates of BCS, with a summary estimate odds ratios (OR) of 4.54 (95% CI 2.03–10.17). The pooled data revealed that BCS patients who achieved pCR after NAC had significantly lower rates of LRFS (RR = 0.59, 95% CI 0.38–0.92) and DRFS (RR = 0.27, 95% CI 0.13–0.55). Better DFS (RR = 0.09, 95% CI 0.04–0.25) and OS (RR = 0.36, 95% CI 0.03–3.90) were also seen, but OS was not significantly different.ConclusionsThe rate of successful BCS is higher in the cCR group than in the non-cCR group, means cCR after NAC can encourage patients to receive BCS. The achievement of pCR after NAC in BCS patients was associated with a good prognosis in terms of LRFS and DRFS, but its value in DFS and OS requires further investigation.Electronic supplementary materialThe online version of this article (10.1186/s12957-017-1273-6) contains supplementary material, which is available to authorized users.

Clinical outcome and predictive factors for docetaxel and epirubicin neoadjuvant chemotherapy of locally advanced breast cancer

“…Triple negative breast cancer and lack of pathological response were associated with higher locoregional recurrence risk. Li et al [ 16 ] reported the results of meta-analysis that patients who achieved a pCR after NAC had significantly lower rates of local and distant RFS.…”

<p>Pretreatment Systemic Inflammation Response Index in Patients with Breast Cancer Treated with Neoadjuvant Chemotherapy as a Useful Prognostic Indicator</p>

“…All enrolled cases were diagnosed and confirmed by core needle biopsy prior to NACT. Before NACT, 8 were triple-negative subtype, respectively. There was no significant association between tumor molecular subtypes and SIRI (Table 4).…”

“…[5][6][7] Neoadjuvant chemotherapy (NACT) is the gold standard of care for locally advanced cancer and has been widely used to the treatment for locally advanced breast cancer. 8 According to the NACT for breast cancer, the breast-conserving surgery rate is increasing, and the tumor stage is decreasing. 9 Many NACT regimens have been applied to the treatment for breast cancer; however, there are no internationally generally accepted NACT regimens for patients with advanced breast carcinoma.…”

Prognostic Nutritional Index (PNI) in Patients With Breast Cancer Treated With Neoadjuvant Chemotherapy as a Useful Prognostic Indicator

“…Neoadjuvant chemotherapy (NACT) is the standard of care for breast cancer with aggressive biological features ( Li et al, 2017 ). NACT can improve the resectability of locally advanced breast cancer and inflammatory breast cancer, decrease the pathology stage and improve the feasibility and cosmetic effect of breast-conserving surgery, and decrease morbidity and the extent of axillary surgery in women with significant nodal disease ( Echeverria et al, 2019 ).…”