Neoadjuvant chemotherapy for breast cancer in Italy: A Senonetwork analysis of 37,215 patients treated from 2017 to 2022
A. De Luca,
M.I. Amabile,
F. Santori,
S. Di Matteo,
M. Tomatis,
A. Ponti,
F. Frusone,
M. Taffurelli,
C. Tinterri,
L. Marotti,
M. Calabrese,
C. Marchiò,
F. Puglisi,
I. Palumbo,
L. Fortunato
Affiliations
A. De Luca
Department of Surgery, Sapienza University of Rome, Rome, Italy
M.I. Amabile
Department of Surgery, Sapienza University of Rome, Rome, Italy; Corresponding author. Department of Surgery, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy.
F. Santori
Breast Center, Azienda Ospedaliera San Giovanni-Addolorata, Rome, Italy; Surgical Residency Program, University of Tor Vergata, Rome, Italy
S. Di Matteo
Breast Center, Azienda Ospedaliera San Giovanni-Addolorata, Rome, Italy; Surgical Residency Program, Federico II University, Naples, Italy
M. Tomatis
AOU Città della Salute e della Scienza, CPO Piemonte and SENONETWORK Data, Warehouse, Turin, Italy
A. Ponti
AOU Città della Salute e della Scienza, CPO Piemonte and SENONETWORK Data, Warehouse, Turin, Italy
F. Frusone
Department of Surgery, Sapienza University of Rome, Rome, Italy
M. Taffurelli
IRCCS Policlinico S. Orsola Hospital, University of Bologna, Bologna, Italy
C. Tinterri
Humanitas Research Hospital and Cancer Center, Breast Surgery, Rozzano, Italy
L. Marotti
Eusoma, Florence, Italy
M. Calabrese
Department of Radiology, IRCCS-Ospedale Policlinico San Martino, Genoa, Italy
C. Marchiò
Department of Medical Sciences, University of Turin, Turin, Italy; Pathology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
F. Puglisi
Department of Medicine, University of Udine, Udine, Italy; Department of Medical Oncology, National Cancer Institute, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, PN, Italy
I. Palumbo
Internal Medicine and Oncology, Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy
L. Fortunato
Breast Center, Azienda Ospedaliera San Giovanni-Addolorata, Rome, Italy
Background: Adoption of neoadjuvant chemotherapy (NACT) in the “real world” has been poorly investigated. Aim of this study was to examine the rate of NACT in Italy, trends over time and determinants of therapeutic choices. Methods: Senonetwork, the recognized network of Breast Centers in Italy, has developed a voluntary national data warehouse with the aim to monitor and improve treatments quality. A retrospective analysis was conducted among 58,661 breast cancer (BC) patients treated between 2017 and 2022 by 24 high-volume Breast Centers participating in the project. Results: After subset exclusion, 37,215 primary BC patients were analysed, 32,933 underwent primary-breast-surgery and 4,282 underwent NACT. From 2017 to 2022, the overall NACT incidence increased particularly for HR-/HER2+, Triple-Negative, and HR+/HER2+ BC (p < 0.001). In cN + patients the recommendation to axillary lymph-node dissection after NACT decreased over time along with an increase of <4 lymph-nodes removed (p < 0.001). Immediate breast reconstruction and indication for nipple sparing mastectomy increased significantly over time (OR = 1.10, p = 0.011 and OR 1.14, p < 0.001, respectively). On multivariate analysis, there was a trend towards an increased adoption of conservative treatment for HR-/HER2+ (p = 0.01) and Triple Negative tumors (p = 0.06). Implementation of NACT varied significantly among Breast-Centers from 3.8 to 17.7 % (p < 0.001). Conclusion: The impact of NACT on the subsequent surgical management is substantial and continues to evolve over time, resulting in less-extensive surgery. Even among high-volume Centers NACT implementation rate is still highly variable. Although we registered a significant increase in its use during the study period, these results need to be further improved.
