Feasibility of neoadjuvant chemotherapy combined with breast conserving surgery for breast cancer

Objective: To investigate the feasibility of breast conserving surgery (BCS) for breast cancer after neoadjuvant chemotherapy (NAC). Methods: A retrospective analysis of 114 breast cancer patients who were confirmed by crude coreneedle histologic examination from January 2006 to December 2008 was conducted, including 21 patients of stage IIA, 69 patients of stage IIB and 24 patients of stage IIIA; 35 patients received NAC-BCS, and 79 patients received NAC-modified radical mastectomy (MRM) for breast cancer. The overall survival (OS) and progression-free survival (PFS) were followed-up. The relationships of family history of cancer, tumor size, lymph node metastasis, TNM stage, estrogen receptor, progesterone receptor, human epidermal growth factor receptor-2, molecular type, postoperative radiotherapy, NAC and targeted therapy with PFS and OS were analyzed. Results: The median follow-up period was 78 months (range: 3-139 months). In NAC-BCS group, 10-year OS rates of stage Ⅱ and stage ⅢA patients were 96.8% and 100.0%, respectively, and the 10-year PFS rates were 93.5% and 75.0%, respectively. In NAC-MRM group, 10-year OS rates of stage Ⅱ and stage ⅢA patients were 86.4% and 70.0%, respectively, and the 10-year PFS rates were 78.0% and 60.0%, respectively. There were no significant differences in PFS (P = 0.091, P = 0.203) of stage Ⅱ and stage ⅢA patients. The cosmetic results showed a good rate of 85.7% (30/35) after BCS in NAC-BCS group. Univariate analysis showed that the tumor size was significantly correlated to DFS (P < 0.001). The response to NAC was significantly correlated to OS (P = 0.019). Multivariate analysis showed that tumor size was an independent prognostic factor of DFS in NAC-BCS group [hazard ratio: 2.537 (95% confidence interval: 0.916-6.485), P = 0.044]. Conclusion: NAC combined with BCS is feasible and can achieve a better cosmetic results and high quality of life in patients with breast cancer. DOI:10.3781/j.issn.1000-7431.2018.33.759