Risk Factors for Ipsilateral Breast Tumor Recurrence in Triple-Negative or HER2-Positive Breast Cancer Patients Who Achieve a Pathologic Complete Response After Neoadjuvant Chemotherapy

Ishitobi, Makoto; Matsuda, Naoko; Tazo, Mizuho; Nakayama, Sadayoshi; Tokui, Ryu; Ogawa, Tomoko; Yoshida, Atsushi; Kojima, Yasuyuki; Kuwayama, Takashi; Nakayama, Takahiro; Yamauchi, Hideko; Nakamura, Seigo; Tsugawa, Koichiro; Hayashi, Naoki

doi:10.1245/s10434-020-09176-0

Cited by 6 publications

(8 citation statements)

References 26 publications

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“…In the present study, the estimated 5-year IBTR rate with omission of breast surgery was significantly lower among patients with a preference to omit breast surgery (median, 10%) than among those who did not have this preference (median, 30%). However, the median estimated 5-year IBTR rate of 10% among patients who wished to omit breast surgery was markedly higher than expected because we provided a reference value from a previous report on the questionnaire (9), in which a rate of approximately 3% was considered acceptable and approximately 12% was considered unacceptable. To date, there is only one prospective clinical trial investigating the safety of omitting surgery among patients who have an exceptional response to NAC (5).…”

Section: Discussionmentioning

confidence: 89%

“…This result is quite promising; however, caution is needed owing to the small sample size and short follow-up period. Several studies have reported the IBTR or loco-regional recurrence rate among patients with triple-negative or HER2-positive tumors who achieve a pCR after NAC and breast-conserving treatment (9,14,15). In these studies, the 5-year IBTR and loco-regional recurrence rate was 0% to 4.5% (9,14) and 0% to 2.6% (15), respectively, which is also lower than 10%.…”

Section: Discussionmentioning

confidence: 96%

“…Several studies have reported the IBTR or loco-regional recurrence rate among patients with triple-negative or HER2-positive tumors who achieve a pCR after NAC and breast-conserving treatment (9,14,15). In these studies, the 5-year IBTR and loco-regional recurrence rate was 0% to 4.5% (9,14) and 0% to 2.6% (15), respectively, which is also lower than 10%. It was surprising that patients who preferred to omit breast surgery would accept a high rate of 10%; this finding provides an important insight for future clinical trials investigating breast surgery omission.…”

Section: Discussionmentioning

confidence: 96%

“…Responses to this question were from 0% to 100%. For this question, we provided a reference value from a previous report (9), which stated that a percent likelihood of breast cancer recurrence of approximately 3% was considered acceptable and approximately 12% was considered unacceptable. The same question was asked for the scenario in which breast surgery is omitted.…”

Section: Methodsmentioning

confidence: 99%

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Preferences Regarding Breast Surgery Omission Among Patients With Breast Cancer Who Receive Neoadjuvant Chemotherapy

Nakamura

Ishitobi

Oshiro

et al. 2023

In Vivo

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Background/Aim: Currently, several ongoing prospective studies are investigating the safety of breast surgery omission in patients with breast cancer who are exceptional responders to neoadjuvant chemotherapy. However, there is little information about the preferences of these patients regarding omission of breast surgery. Patients and Methods: We conducted a questionnaire survey to assess preferences regarding omission of breast surgery among patients with breast cancer who had human epidermal growth factor receptor 2-positive or estrogen receptornegative tumors and good clinical response after neoadjuvant chemotherapy. Patients' estimation of the risk of ipsilateral breast tumor recurrence (IBTR) after definitive surgery or breast surgery omission was also assessed. Results: Of 93 patients, only 22 (23.7%) said they would omit breast surgery. Under the scenario of omitting breast surgery, the 5-year IBTR rate estimated by patients who said they would omit breast surgery was significantly lower (median, 10%) than the rate estimated by patients who preferred undergoing definitive surgery (median, 30%) (p=0.017). Conclusion: The proportion of our surveyed patients who were willing to omit breast surgery was low. Patients who said they preferred to omit breast surgery overestimated the 5-year IBTR risk.Neoadjuvant chemotherapy (NAC) for breast cancer has become the standard therapy not only for locally advanced cases but also for operable, early-stage breast cancer. Recently, owing to the advances in chemotherapy and targeted therapy, the rate of pathologic complete response (pCR) is reaching 60% among human epidermal growth factor receptor 2 (HER2)-positive and triple-negative breast cancer (1, 2). This finding has attracted physicians' interest in "breast surgery omission" in reference to the ultimate breast-conserving therapy (3). Several ongoing worldwide prospective studies are investigating the safety of breast surgery omission in patients with breast cancer who are exceptional responders to NAC (4, 5). To date, however, these prospective studies have not provided sufficient safety data on omission of breast surgery.In addition of the lack of safety data about breast surgery omission, a remaining problem for the introduction of breast surgery omission into clinical practice is the lack of information about the preferences of patients with breast cancer. In their commentary to an article about research into breast surgery omission, Caballero et al. stated that an important aspect of de-escalation strategies such as breast surgery omission is to listen to the patient's perspective during the early stages of developing future clinical trials, and to 794

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 96%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Preferences Regarding Breast Surgery Omission Among Patients With Breast Cancer Who Receive Neoadjuvant Chemotherapy

Nakamura

Ishitobi

Oshiro

et al. 2023

In Vivo

View full text Add to dashboard Cite

show abstract

“…In previous studies, other risk factors except for molecular subtypes of tumors have been reported. Young age, clinical T stage, and clinical N stage were referred to as risk factors for recurrence including LRR and distant metastases after achieving pCR ( 31 – 36 ). According to Ishitobi et al., patients who were younger than 40 years at the time of diagnosis had significantly worse IBTR-free survival than those who were 40 years or older (5-year IBTR-free survival, 87.7 vs 96.9%; p = .002) ( 31 ).…”

Section: Discussionmentioning

confidence: 99%

Risk factors of breast cancer recurrence in pathologic complete response achieved by patients following neoadjuvant chemotherapy: a single-center retrospective study

Choi,

Woen,

Jang

et al. 2023

Front. Oncol.

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ObjectivePathologic complete response (pCR) of breast cancer after neoadjuvant chemotherapy (NAC) is highly related to molecular subtypes. Patients who achieved tumor pCR after NAC have a better prognosis. However, despite of better prognosis, pCR patients have a potential for recurrence. There is little evidence of risk factors of recurrence in patients with pCR. We aim to analyze factors associated with tumor recurrence in patients who achieved pCR.MethodsThis study retrospectively reviewed the data of patients diagnosed with breast cancer who achieved pCR after receiving NAC between January 2009 and December 2018 in Samsung Medical Center. pCR was defined as no residual invasive cancer in the breast and axillary nodes even if there is residual ductal carcinoma in situ (ypT0 or ypTis with ypN0). Breast cancers are classified into 4 subtypes based on hormone receptors (HR) and human epithelial growth factor receptor 2 (HER2) status. Patients who had bilateral breast cancer, ipsilateral supraclavicular or internal mammary lymph node metastasis, inflammatory breast cancer, distant metastasis, unknown subtype, and histologically unique case were excluded from the study.ResultsIn total 483 patients were included in this study except for patients who corresponded to the exclusion criteria. The median follow-up duration was 59.0 months (range, 0.5-153.3 months). Breast cancer recurred in 4.1% of patients (20 of 483). There was a significant difference in clinical T (P = 0.004) and clinical N (P = 0.034) stage in the Kaplan-Meier curve for disease-free survival. Molecular subtypes (P = 0.573), Ki67 (P = 1.000), and breast surgery type (P = 0.574) were not associated with tumor recurrence in patients who achieved pCR after NAC. In the clinical T stage and clinical N stage, there was a significant difference between recurrence and no-recurrence groups (clinical T stage; P = 0.045, clinical N stage; P = 0.002). Univariable Cox regression revealed statistical significance in the clinical T stage (P = 0.049) and clinical N stage (P = 0.010), while multivariable Cox regression demonstrated non-significance in the clinical T stage (P = 0.320) and clinical N stage (P = 0.073).ConclusionResults in this study showed that clinical T, clinical N stage, and molecular subtypes were not statistically significant predictors of recurrence in patients who achieved pCR after NAC. In spite of that, pCR after NAC may be more important than clinical staging and molecular subtype in early breast cancer. In addition, escalated treatments for patients with HER2 + or triple-negative tumors would be considered with a strict patient selection strategy to prevent over-treatment as well as achieve pCR.

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Strahlentherapeutische Konzepte nach Neoadjuvanz

et al. 2023

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Risk Factors for Ipsilateral Breast Tumor Recurrence in Triple-Negative or HER2-Positive Breast Cancer Patients Who Achieve a Pathologic Complete Response After Neoadjuvant Chemotherapy

Cited by 6 publications

References 26 publications

Preferences Regarding Breast Surgery Omission Among Patients With Breast Cancer Who Receive Neoadjuvant Chemotherapy

Preferences Regarding Breast Surgery Omission Among Patients With Breast Cancer Who Receive Neoadjuvant Chemotherapy

Risk factors of breast cancer recurrence in pathologic complete response achieved by patients following neoadjuvant chemotherapy: a single-center retrospective study

Strahlentherapeutische Konzepte nach Neoadjuvanz

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