Locoregional recurrence after neoadjuvant versus adjuvant chemotherapy based on tumor subtypes in patients with early-stage breast cancer: A multi-institutional retrospective cohort study
Jong-Ho Cheun,
Youngji Kwak,
Eunhye Kang,
Ji-Jung Jung,
Hong-Kyu Kim,
Han-Byoel Lee,
Kyung-Hun Lee,
Hyeong-Gon Moon,
Ki-Tae Hwang,
Yeon Hee Park,
Jeong Eon Lee,
Wonshik Han
Affiliations
Jong-Ho Cheun
Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
Youngji Kwak
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
Eunhye Kang
Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
Ji-Jung Jung
Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
Hong-Kyu Kim
Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
Han-Byoel Lee
Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
Kyung-Hun Lee
Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
Hyeong-Gon Moon
Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
Ki-Tae Hwang
Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
Yeon Hee Park
Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
Jeong Eon Lee
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Corresponding author. Department of Surgery, Samsung Medical Center, Sungkyunkwan University College of Medicine 81, Irwan-Dong, Kangnam-Gu, Seoul 135-710, Republic of Korea.
Wonshik Han
Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; Corresponding author. Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, Seoul 03080, Republic of Korea.
Background: Neoadjuvant chemotherapy (NACT) for early-stage breast cancer is associated with an increased risk of locoregional recurrence (LRR). We investigated whether the risk of LRR after NACT varies across tumor subtypes. Methods: We retrospectively reviewed the medical records of women who underwent breast-conserving surgery for breast cancer at three institutions between January 1, 2004, and December 31, 2018. Patients received either NACT or adjuvant chemotherapy (ACT), followed by radiotherapy. LRR was analyzed according to the hormone receptor (HR) and human epidermal growth factor receptor-2 (HER2) status using propensity score matching, log-rank test, and Cox regression analysis. Results: Among 10,328 patients, 2479 (24.0 %) received NACT. Within the median follow-up of 84.5 (IQR, 35.1–118.5) months, the 10-year LRR-free survival rates were 94.5 % and 90.7 % for the ACT and NACT groups, respectively (hazard ratio: 2.04, 95 % confidence interval [CI]: 1.68–2.46, p < 0.0001). NACT was significantly associated with higher LRR in the HR+/HER2− (hazard ratio: 2.52, 95 % CI: 1.83–3.46, p < 0.0001) and HR−/HER2− (hazard ratio: 1.85, 95 % CI: 1.37–2.50, p < 0.0001) subtypes. In the HR+/HER2− subtype, the elevated risk remained significant after propensity-score matching and Cox-regression analysis. However, NACT was not associated with LRR in the HR−/HER2− subtype after adjusting for other variables. Annual LRR pattern among the HR+/HER2− subtype showed the highest incidence in the early period of treatment. Conclusion: Patients with the HR+/HER2− subtype showed an increased risk of LRR after NACT, while those with other subtypes showed comparable LRR-free survival.
