Does the Type of Surgery After Preoperative Systemic Therapy for T3/T4 Breast Cancer Impact Survival?
Jamila Alazhri1,4*, Tulay Koru-Sengul2,3, Feng Miao3, Margaret M Byrne2,5 and Eli Avisar1,3
1Division of Surgical Oncology, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
2Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
3Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
4Division of Breast and Endocrine Surgery, Department of Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia
5H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
*Corresponding Author: Jamila Alazhri, Breast and Endocrine Surgery Division, Department of Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia.
April 01, 2021; Published: May 21, 2021
Introduction: Our purpose was to study the impact of the extent of surgery on survival of women with T3/T4 breast cancer treated with preoperative systemic therapy (PST) in form of chemotherapy, hormonal therapy, or both.
Methods: Population-based Florida Cancer Data Registry was screened for women diagnosed with T3/T4 breast cancer who received PST followed by either breast conserving surgery (BCS) or mastectomy. A multivariable Cox regression model was used to identify significant predictors of overall survival. Adjusted hazard ratio (aHR) and 95% confidence interval (95%CI) were calculated.
Results: Out of 712 patients receiving PST, 72 (10%) had BCS and 640 (90%) had mastectomy. After covariable adjustment, patients who received both chemo and hormonal PST had better prognosis than patients with chemotherapy alone (aHR=1.90, 95%CI: 1.20 - 3.01, p = 0.006) or hormonal therapy alone (1.95, 0.84 - 4.56, p = 0.122). Hispanic origin (0.50, 0.27 - 0.92, p = 0.027) positively impacted survival. Medicare (1.70, 1.08 - 2.68, p = 0.021) and uninsured (1.69, 1.10 - 2.60, p = 0.016) compared to private insurance, poorly-differentiated/undifferentiated (2.24, 1.04 - 4.82, p = 0.039) compared to well-differentiated grade, and distant SEER stage (4.13, 1.68 - 10.12, p = 0.002) compared to localized were significant predictors of worse survival. There was no significant difference in survival between women who had mastectomy compared to BCS (1.35, 0.82 - 2.21, p = 0.234). In the subgroup of patients who had mastectomy, radiotherapy resulted in significantly better survival than no radiotherapy (HR 0.68, 0.47-0.99, p = 0.044).
Conclusion: The type of surgery after PST for T3/T4 breast cancer does not impact overall survival. BCS could be considered for patients with T3/T4 tumors after PST.
Keywords: Locally Advanced Breast Cancer; T3 Breast Cancer; T4 Breast Cancer; Preoperative Systemic Therapy; Neoadjuvant Chemotherapy; Breast Conserving Surgery; Mastectomy; Florida
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