Does the Timing of Surgery after Neoadjuvant Therapy in Breast Cancer Patients Affect the Outcome?
Background:There is a paucity of literature examining the impact of timing of surgery after neoadjuvant chemotherapy. Objective:This study aimed to analyze the impact of the time taken to initiate surgical treatment following completion of neoadjuvant chemotherapy on patients’ outcomes by evaluating...
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| Veröffentlicht in: | Oncology 2020-02, Vol.98 (3), p.168-173 |
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| creator | Suleman, Kausar Almalik, Osama Haque, Emaan Mushtaq, Ali Badran, Ahmed Alsayed, Adher Ajarim, Dahish Al-Tweigeri, Taher Jastaniyah, Noha Elhassan, Tusneem Alkhayal, Wafa |
| description | Background:There is a paucity of literature examining the impact of timing of surgery after neoadjuvant chemotherapy. Objective:This study aimed to analyze the impact of the time taken to initiate surgical treatment following completion of neoadjuvant chemotherapy on patients’ outcomes by evaluating their pathological response, overall survival (OS), and disease-free survival (DFS). Methods:This is a retrospective review of 611 patients diagnosed with stage II and III breast cancer that received neoadjuvant chemotherapy and surgery between January 2004 and December 2014. The data was collected from a prospectively gathered registry. The patients were stratified into three cohorts according to the time of surgery after neoadjuvant chemotherapy: |
| doi_str_mv | 10.1159/000504964 |
| format | Article |
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Objective:This study aimed to analyze the impact of the time taken to initiate surgical treatment following completion of neoadjuvant chemotherapy on patients’ outcomes by evaluating their pathological response, overall survival (OS), and disease-free survival (DFS). Methods:This is a retrospective review of 611 patients diagnosed with stage II and III breast cancer that received neoadjuvant chemotherapy and surgery between January 2004 and December 2014. The data was collected from a prospectively gathered registry. The patients were stratified into three cohorts according to the time of surgery after neoadjuvant chemotherapy: <4 weeks, 4–7 weeks, or ≥8 weeks. Outcomes were assessed using Kaplan-Meier curves, and the variables were compared using log-rank statistics. Results:The 5-year OS rate was 89.6% and the 5-year DFS rate was 74%. OS and DFS were not significantly different when stratified according to timing of surgery; however, the trends of OS and DFS were poor when surgery was delayed for ≥8 weeks. Median OS and median DFS have not yet been reached. Of the 17% of patients that had surgery after ≥8 weeks, 12.9% had pathological complete response (pCR), while among those that received surgery 4–7 weeks and <4 weeks after neoadjuvant chemotherapy, 26% and 21% had pCR, respectively (p = 0.02). ER+/HER-2+ patients had a statistically significant decrease in pCR if surgery was performed after ≥8 weeks. Conclusion:Our patients showed improved pCR if surgery was performed within 8 weeks, especially for ER+/HER-2+ patients. All patients had better OS and DFS trends if surgery was performed between 4 and 7 weeks after neoadjuvant chemotherapy.</description><identifier>ISSN: 0030-2414</identifier><identifier>EISSN: 1423-0232</identifier><identifier>DOI: 10.1159/000504964</identifier><identifier>PMID: 31918425</identifier><language>eng</language><publisher>Basel, Switzerland: S. Karger AG</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Breast ; Breast cancer ; Breast Neoplasms - mortality ; Breast Neoplasms - pathology ; Breast Neoplasms - therapy ; Care and treatment ; Chemotherapy, Adjuvant ; Clinical Study ; Development and progression ; Disease Progression ; Disease-Free Survival ; Evaluation ; Female ; Humans ; Mastectomy - adverse effects ; Mastectomy - mortality ; Methods ; Middle Aged ; Neoadjuvant therapy ; Neoadjuvant Therapy - adverse effects ; Neoadjuvant Therapy - mortality ; Neoplasm Staging ; Patient outcomes ; Prognosis ; Registries ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Surgery ; Time Factors ; Time-to-Treatment ; Young Adult</subject><ispartof>Oncology, 2020-02, Vol.98 (3), p.168-173</ispartof><rights>2020 S. Karger AG, Basel</rights><rights>2020 S. Karger AG, Basel.</rights><rights>COPYRIGHT 2020 S. Karger AG</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c432t-c06850a63fb32e96d681851720de1b69080c2a95f5e8d01dc2932a8ff08ad2193</citedby><cites>FETCH-LOGICAL-c432t-c06850a63fb32e96d681851720de1b69080c2a95f5e8d01dc2932a8ff08ad2193</cites><orcidid>0000-0003-4644-2050 ; 0000-0001-9994-8878 ; 0000-0003-1939-1665</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,2429,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31918425$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Suleman, Kausar</creatorcontrib><creatorcontrib>Almalik, Osama</creatorcontrib><creatorcontrib>Haque, Emaan</creatorcontrib><creatorcontrib>Mushtaq, Ali</creatorcontrib><creatorcontrib>Badran, Ahmed</creatorcontrib><creatorcontrib>Alsayed, Adher</creatorcontrib><creatorcontrib>Ajarim, Dahish</creatorcontrib><creatorcontrib>Al-Tweigeri, Taher</creatorcontrib><creatorcontrib>Jastaniyah, Noha</creatorcontrib><creatorcontrib>Elhassan, Tusneem</creatorcontrib><creatorcontrib>Alkhayal, Wafa</creatorcontrib><title>Does the Timing of Surgery after Neoadjuvant Therapy in Breast Cancer Patients Affect the Outcome?</title><title>Oncology</title><addtitle>Oncology</addtitle><description>Background:There is a paucity of literature examining the impact of timing of surgery after neoadjuvant chemotherapy. Objective:This study aimed to analyze the impact of the time taken to initiate surgical treatment following completion of neoadjuvant chemotherapy on patients’ outcomes by evaluating their pathological response, overall survival (OS), and disease-free survival (DFS). Methods:This is a retrospective review of 611 patients diagnosed with stage II and III breast cancer that received neoadjuvant chemotherapy and surgery between January 2004 and December 2014. The data was collected from a prospectively gathered registry. The patients were stratified into three cohorts according to the time of surgery after neoadjuvant chemotherapy: <4 weeks, 4–7 weeks, or ≥8 weeks. Outcomes were assessed using Kaplan-Meier curves, and the variables were compared using log-rank statistics. Results:The 5-year OS rate was 89.6% and the 5-year DFS rate was 74%. OS and DFS were not significantly different when stratified according to timing of surgery; however, the trends of OS and DFS were poor when surgery was delayed for ≥8 weeks. Median OS and median DFS have not yet been reached. Of the 17% of patients that had surgery after ≥8 weeks, 12.9% had pathological complete response (pCR), while among those that received surgery 4–7 weeks and <4 weeks after neoadjuvant chemotherapy, 26% and 21% had pCR, respectively (p = 0.02). ER+/HER-2+ patients had a statistically significant decrease in pCR if surgery was performed after ≥8 weeks. Conclusion:Our patients showed improved pCR if surgery was performed within 8 weeks, especially for ER+/HER-2+ patients. All patients had better OS and DFS trends if surgery was performed between 4 and 7 weeks after neoadjuvant chemotherapy.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Breast</subject><subject>Breast cancer</subject><subject>Breast Neoplasms - mortality</subject><subject>Breast Neoplasms - pathology</subject><subject>Breast Neoplasms - therapy</subject><subject>Care and treatment</subject><subject>Chemotherapy, Adjuvant</subject><subject>Clinical Study</subject><subject>Development and progression</subject><subject>Disease Progression</subject><subject>Disease-Free Survival</subject><subject>Evaluation</subject><subject>Female</subject><subject>Humans</subject><subject>Mastectomy - adverse effects</subject><subject>Mastectomy - mortality</subject><subject>Methods</subject><subject>Middle Aged</subject><subject>Neoadjuvant therapy</subject><subject>Neoadjuvant Therapy - adverse effects</subject><subject>Neoadjuvant Therapy - mortality</subject><subject>Neoplasm Staging</subject><subject>Patient outcomes</subject><subject>Prognosis</subject><subject>Registries</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Surgery</subject><subject>Time Factors</subject><subject>Time-to-Treatment</subject><subject>Young Adult</subject><issn>0030-2414</issn><issn>1423-0232</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpt0c2LEzEYBvAgiltXD95FAguih1nzvZOT1PoJxQrW85Bm3rRZZ5JukhH63zt11uLCkkMg-T0vvDwIPafkklKp3xJCJBFaiQdoRgXjFWGcPUQzQjipmKDiDD3J-XpkV1Kox-iMU01rweQMbT5EyLjsAK9978MWR4d_DGkL6YCNK5DwN4imvR5-m1DwegfJ7A_YB_w-gckFL0ywI_puiodQMp47B7b8Hbgaio09vHuKHjnTZXh2e5-jn58-rhdfquXq89fFfFlZwVmpLFG1JEZxt-EMtGpVTWtJrxhpgW6UJjWxzGjpJNQtoa1lmjNTO0dq0zKq-Tl6Pc3dp3gzQC5N77OFrjMB4pAbxrliQlCtRnox0a3poPHBxZKMPfJmriTTshaEj-ryHjWeFnpvYwDnx_c7gVf_BXZgurLLsRuKjyHfhW8maFPMOYFr9sn3Jh0aSppjpc2p0tG-vF1r2PTQnuS_DkfwYgK_zLG3EzjlL-79Xi2Wk2j2reN_AGF-rGs</recordid><startdate>20200201</startdate><enddate>20200201</enddate><creator>Suleman, Kausar</creator><creator>Almalik, Osama</creator><creator>Haque, Emaan</creator><creator>Mushtaq, Ali</creator><creator>Badran, Ahmed</creator><creator>Alsayed, Adher</creator><creator>Ajarim, Dahish</creator><creator>Al-Tweigeri, Taher</creator><creator>Jastaniyah, Noha</creator><creator>Elhassan, Tusneem</creator><creator>Alkhayal, Wafa</creator><general>S. Karger AG</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-4644-2050</orcidid><orcidid>https://orcid.org/0000-0001-9994-8878</orcidid><orcidid>https://orcid.org/0000-0003-1939-1665</orcidid></search><sort><creationdate>20200201</creationdate><title>Does the Timing of Surgery after Neoadjuvant Therapy in Breast Cancer Patients Affect the Outcome?</title><author>Suleman, Kausar ; Almalik, Osama ; Haque, Emaan ; Mushtaq, Ali ; Badran, Ahmed ; Alsayed, Adher ; Ajarim, Dahish ; Al-Tweigeri, Taher ; Jastaniyah, Noha ; Elhassan, Tusneem ; Alkhayal, Wafa</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c432t-c06850a63fb32e96d681851720de1b69080c2a95f5e8d01dc2932a8ff08ad2193</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Breast</topic><topic>Breast cancer</topic><topic>Breast Neoplasms - mortality</topic><topic>Breast Neoplasms - pathology</topic><topic>Breast Neoplasms - therapy</topic><topic>Care and treatment</topic><topic>Chemotherapy, Adjuvant</topic><topic>Clinical Study</topic><topic>Development and progression</topic><topic>Disease Progression</topic><topic>Disease-Free Survival</topic><topic>Evaluation</topic><topic>Female</topic><topic>Humans</topic><topic>Mastectomy - adverse effects</topic><topic>Mastectomy - mortality</topic><topic>Methods</topic><topic>Middle Aged</topic><topic>Neoadjuvant therapy</topic><topic>Neoadjuvant Therapy - adverse effects</topic><topic>Neoadjuvant Therapy - mortality</topic><topic>Neoplasm Staging</topic><topic>Patient outcomes</topic><topic>Prognosis</topic><topic>Registries</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Surgery</topic><topic>Time Factors</topic><topic>Time-to-Treatment</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Suleman, Kausar</creatorcontrib><creatorcontrib>Almalik, Osama</creatorcontrib><creatorcontrib>Haque, Emaan</creatorcontrib><creatorcontrib>Mushtaq, Ali</creatorcontrib><creatorcontrib>Badran, Ahmed</creatorcontrib><creatorcontrib>Alsayed, Adher</creatorcontrib><creatorcontrib>Ajarim, Dahish</creatorcontrib><creatorcontrib>Al-Tweigeri, Taher</creatorcontrib><creatorcontrib>Jastaniyah, Noha</creatorcontrib><creatorcontrib>Elhassan, Tusneem</creatorcontrib><creatorcontrib>Alkhayal, Wafa</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Suleman, Kausar</au><au>Almalik, Osama</au><au>Haque, Emaan</au><au>Mushtaq, Ali</au><au>Badran, Ahmed</au><au>Alsayed, Adher</au><au>Ajarim, Dahish</au><au>Al-Tweigeri, Taher</au><au>Jastaniyah, Noha</au><au>Elhassan, Tusneem</au><au>Alkhayal, Wafa</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Does the Timing of Surgery after Neoadjuvant Therapy in Breast Cancer Patients Affect the Outcome?</atitle><jtitle>Oncology</jtitle><addtitle>Oncology</addtitle><date>2020-02-01</date><risdate>2020</risdate><volume>98</volume><issue>3</issue><spage>168</spage><epage>173</epage><pages>168-173</pages><issn>0030-2414</issn><eissn>1423-0232</eissn><abstract>Background:There is a paucity of literature examining the impact of timing of surgery after neoadjuvant chemotherapy. Objective:This study aimed to analyze the impact of the time taken to initiate surgical treatment following completion of neoadjuvant chemotherapy on patients’ outcomes by evaluating their pathological response, overall survival (OS), and disease-free survival (DFS). Methods:This is a retrospective review of 611 patients diagnosed with stage II and III breast cancer that received neoadjuvant chemotherapy and surgery between January 2004 and December 2014. The data was collected from a prospectively gathered registry. The patients were stratified into three cohorts according to the time of surgery after neoadjuvant chemotherapy: <4 weeks, 4–7 weeks, or ≥8 weeks. Outcomes were assessed using Kaplan-Meier curves, and the variables were compared using log-rank statistics. Results:The 5-year OS rate was 89.6% and the 5-year DFS rate was 74%. OS and DFS were not significantly different when stratified according to timing of surgery; however, the trends of OS and DFS were poor when surgery was delayed for ≥8 weeks. Median OS and median DFS have not yet been reached. Of the 17% of patients that had surgery after ≥8 weeks, 12.9% had pathological complete response (pCR), while among those that received surgery 4–7 weeks and <4 weeks after neoadjuvant chemotherapy, 26% and 21% had pCR, respectively (p = 0.02). ER+/HER-2+ patients had a statistically significant decrease in pCR if surgery was performed after ≥8 weeks. Conclusion:Our patients showed improved pCR if surgery was performed within 8 weeks, especially for ER+/HER-2+ patients. All patients had better OS and DFS trends if surgery was performed between 4 and 7 weeks after neoadjuvant chemotherapy.</abstract><cop>Basel, Switzerland</cop><pub>S. Karger AG</pub><pmid>31918425</pmid><doi>10.1159/000504964</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0003-4644-2050</orcidid><orcidid>https://orcid.org/0000-0001-9994-8878</orcidid><orcidid>https://orcid.org/0000-0003-1939-1665</orcidid></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Breast Breast cancer Breast Neoplasms - mortality Breast Neoplasms - pathology Breast Neoplasms - therapy Care and treatment Chemotherapy, Adjuvant Clinical Study Development and progression Disease Progression Disease-Free Survival Evaluation Female Humans Mastectomy - adverse effects Mastectomy - mortality Methods Middle Aged Neoadjuvant therapy Neoadjuvant Therapy - adverse effects Neoadjuvant Therapy - mortality Neoplasm Staging Patient outcomes Prognosis Registries Retrospective Studies Risk Assessment Risk Factors Surgery Time Factors Time-to-Treatment Young Adult |
| title | Does the Timing of Surgery after Neoadjuvant Therapy in Breast Cancer Patients Affect the Outcome? |
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