Division of Surgical Oncology, Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA.
J Surg Oncol. 2021 Feb;123(2):439-445. doi: 10.1002/jso.26301. Epub 2020 Dec 1.
Neoadjuvant chemotherapy (NAC) increases breast-conserving surgery (BCS) rates with comparable locoregional control and survival outcomes to adjuvant therapy. More women are receiving NAC and achieving pathologic complete responses (pCR). This study sought to evaluate the effect of NAC on surgical outcomes after the adoption of a "no-ink-on-tumor" margin policy in patients undergoing primary BCS (PBSC).
An IRB approved database was queried for women undergoing BCS for invasive breast cancer after March 2014. We compared patients who underwent NAC followed by BCS versus PBCS. Demographic, tumor, treatment, and outcome variables were compared using both univariate and multivariable analysis.
A total of 162 patients were evaluated. NAC patients had significantly lower re-excision rates (0% NAC vs. 9% PBCS, p = .03), margin positivity (0% NAC vs. 5% PBCS, p = .01), and greater patient satisfaction with breast cosmesis (97 NAC vs. 77 PBCS, p = .01). On multivariable analysis, NAC was not an independent predictor of lower final resection volume, total complications, or greater satisfaction with breasts when controlling for age and T category at diagnosis.
NAC followed by BCS may offer less margin positivity, lower re-excision rates, and greater patient satisfaction when compared to a contemporary PBCS cohort in the "no-ink-on-tumor" era.
新辅助化疗（NAC）增加了保乳手术（BCS）的比率，其局部区域控制和生存结果与辅助治疗相当。越来越多的女性接受 NAC 治疗并实现了病理完全缓解（pCR）。本研究旨在评估在对接受原发性 BCS（PBSC）的患者采用“无肿瘤墨水”切缘政策后，NAC 对手术结果的影响。
一项经机构审查委员会批准的数据库被查询用于寻找 2014 年 3 月后接受 BCS 治疗浸润性乳腺癌的女性。我们比较了接受 NAC 后行 BCS 与直接行 BCS 的患者。使用单变量和多变量分析比较了人口统计学、肿瘤、治疗和结局变量。
共评估了 162 例患者。NAC 组的再次切除率显著降低（0% NAC 比 9% PBCS，p=0.03），切缘阳性率降低（0% NAC 比 5% PBCS，p=0.01），且患者对乳房美容的满意度更高（97% NAC 比 77% PBCS，p=0.01）。多变量分析显示，在控制诊断时的年龄和 T 分期后，NAC 并不是最终切除体积更小、总并发症发生率更低或对乳房更满意的独立预测因素。
与“无肿瘤墨水”时代的当代 PBCS 队列相比，NAC 后行 BCS 可能具有更低的切缘阳性率、更低的再次切除率和更高的患者满意度。
