Breast-conserving surgery is not associated with increased local recurrence in patients with early-stage node-negative triple-negative breast cancer treated with neoadjuvant chemotherapy
David Krug,
Valentina Vladimirova,
Michael Untch,
Thorsten Kühn,
Andreas Schneeweiss,
Carsten Denkert,
Beyhan Ataseven,
Christine Solbach,
Bernd Gerber,
Hans Tesch,
Michael Golatta,
Sabine Seiler,
Jörg Heil,
Valentina Nekljudova,
Johannes Holtschmidt,
Sibylle Loibl
Affiliations
David Krug
Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany; Corresponding author. University Hospital Schleswig-Holstein, Campus Kiel, Department of Radiation Oncology, Arnold-Heller-Straße 3, Haus L, 24105 Kiel, Germany.
Valentina Vladimirova
German Breast Group, Neu-Isenburg, Germany
Michael Untch
HELIOS Klinikum Berlin-Buch, Berlin, Germany
Thorsten Kühn
Department of Gynecology and Obstetrics, University of Ulm, Ulm, Germany; Department of Gynecology and Obstectrics, Die Filderklinik, Filderstadt, Germany
Andreas Schneeweiss
National Center for Tumor Diseases, University Hospital and German Cancer Research Center, Heidelberg, Germany
Carsten Denkert
Institut für Pathologie, Philipps-Universität Marburg und Universitätsklinikum Marburg (UKGM), Marburg, Germany
Beyhan Ataseven
Department of Gynecology, Gynecologic Oncology and Obstetrics, Bielefeld University, Medical School and University Medical Center OWL, Klinikum Lippe, Detmold, Germany
Christine Solbach
Goethe University Frankfurt, Department of Gynecology and Obstetrics, University Hospital, Germany
Bernd Gerber
Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany
Hans Tesch
Center for Hematology and Oncology Bethanien, Frankfurt, Germany
Michael Golatta
Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany; Brustzentrum Heidelberg Klinik St. Elisabeth, Max-Reger-Straße 5-7, 69121 Heidelberg, Germany
Sabine Seiler
German Breast Group, Neu-Isenburg, Germany
Jörg Heil
Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany; Brustzentrum Heidelberg Klinik St. Elisabeth, Max-Reger-Straße 5-7, 69121 Heidelberg, Germany
Valentina Nekljudova
German Breast Group, Neu-Isenburg, Germany
Johannes Holtschmidt
German Breast Group, Neu-Isenburg, Germany
Sibylle Loibl
German Breast Group, Neu-Isenburg, Germany; Center for Hematology and Oncology Bethanien, Frankfurt, Germany
Background: Neoadjuvant chemotherapy (NACT) is routinely used for patients with triple-negative breast cancer (TNBC). Upfront breast-conserving therapy (BCT) consisting of breast-conserving surgery (BCS) and adjuvant radiotherapy (RT) has been shown to be associated with improved outcome in patients with early TNBC as compared to mastectomy. Methods: We identified 2632 patients with early TNBC from the German Breast Group meta-database. Patients with cT1-2 cN0 and ypN0, available surgery and follow-up data were enrolled. Data of 1074 patients from 8 prospective NACT trials were available. Endpoints of interest were locoregional recurrence as first site of relapse (LRR), disease-free survival (DFS) and overall survival (OS). We performed univariate and multivariate Fine-Gray analysis and Cox regression models. Results: After a median follow-up of 64 months, there were 94 (8.8%) locoregional events as first site of relapse. Absence of pathologic complete response (pCR) was associated with increased LRR upon uni- and multivariate analysis (hazard ratio [HR] = 2.28; p < 0.001 and HR = 2.22; p = 0.001). Type of surgery was not associated with LRR. Patients in the BCS-group had better DFS and OS (DFS: HR = 0.47; p < 0.001 and OS: HR = 0.40; p < 0.001). BCS was associated with improved DFS and OS upon multivariate analysis (DFS: HR = 0.51; p < 0.001; and OS HR = 0.43; p < 0.001), whereas absence of pCR was associated with worse DFS and OS (DFS: HR = 2.43; p < 0.001; and OS: HR = 3.15; p < 0.001). Conclusions: In this retrospective analysis of patients with early stage node-negative TNBC treated with NACT, BCS was not associated with an increased risk of LRR but with superior DFS and OS.
