Department of Surgery, King Hussein Cancer Center-KHCC, Amman, Jordan.
Breast Cancer Res Treat. 2021 Feb;186(1):7-13. doi: 10.1007/s10549-020-06090-7. Epub 2021 Jan 21.
Neoadjuvant chemotherapy (NACT) is a cornerstone in managing breast cancer. There is no defined consensus on the optimal time between NACT and surgery. We analyze the effect of time between the end of NACT and surgery on overall survival (OS) and disease-free survival (DFS) in breast cancer patients who received NACT followed by surgery.
This is a retrospective analysis of 468 patients with breast cancer (stage I-III) who received and completed the same regimen of NACT (Anthracyclines and Taxanes B27 protocol) at King Hussein Cancer Center (KHCC) (2006-2014). Patients have been divided into three groups according to the duration between the end of NACT and surgery, <4 weeks, 4-8 weeks and >8 weeks.
Most patients were stages II-III breast cancer with only four patients with stage I. Almost all patients (99%) had either invasive ductal or invasive lobular carcinomas. Adjuvant radiotherapy was given to 96% of patients. Most patients were alive at the time of analysis (84%). Complete pathological response was achieved in 20% of patients. Local recurrence rate was 6.6% with a median follow up of 3.8 years (interquartile range 0.6-10.9). Analysis showed that the groups had equivalent DFS. However, OS was adversely affected if patients had their surgery after 8 weeks of NACT compared to those who had their surgery between 4 and 8 weeks.
Breast cancer surgery post NACT within the first 8 weeks had no impact on survival. However, surgery after 8 weeks of NACT showed negative impact on OS. Therefore, delaying surgery after 8 weeks is not recommended.
新辅助化疗（NACT）是治疗乳腺癌的基石。目前对于 NACT 与手术之间的最佳时间尚无明确共识。我们分析了接受 NACT 后行手术的乳腺癌患者中 NACT 结束与手术之间时间对总生存（OS）和无病生存（DFS）的影响。
这是对在侯赛因国王癌症中心（KHCC）（2006-2014 年）接受并完成相同 NACT 方案（蒽环类和紫杉类 B27 方案）的 468 例乳腺癌（I-III 期）患者的回顾性分析。根据 NACT 结束与手术之间的持续时间，患者分为三组，<4 周、4-8 周和>8 周。
大多数患者为 II-III 期乳腺癌，仅有 4 例为 I 期。几乎所有患者（99%）均为浸润性导管癌或浸润性小叶癌。96%的患者接受了辅助放疗。在分析时，大多数患者仍存活（84%）。20%的患者达到完全病理缓解。局部复发率为 6.6%，中位随访时间为 3.8 年（四分位距 0.6-10.9）。分析显示，三组患者的 DFS 相当。然而，如果患者在 NACT 后 8 周内进行手术，与在 4-8 周内进行手术的患者相比，OS 会受到不利影响。
NACT 后 8 周内进行乳腺癌手术对生存没有影响。然而，NACT 后 8 周后进行手术对 OS 有负面影响。因此，不建议延迟 8 周后进行手术。
