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KMID : 1101820170050010016
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Journal of Breast Disease
2017 Volume.5 No. 1 p.16 ~ p.22
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Re-Excision Rate in Breast Conservation Surgery after Neoadjuvant Chemotherapy
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Song Jung-Hyun
Park Jeong-Yeong
Choi Jung-Eun
Kang Su-Hwan
Lee Soo-Jung
Bae Young-Kyung
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Abstract
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Purpose: The purpose of this study was to compare the success rate of re-excision and breast-conserving surgery (BCS) between patients who received neoadjuvant chemotherapy and those who did not.
Methods: In this retrospective cohort study, 256 women who had clinical T2 breast cancer and planned to receive, as initial treatment either BCS (n=197) or neoadjuvant chemotherapy (n=59) between January 2009 and December 2012 were included. The data, including age, initial tumor size, mammographic microcalcification, ultrasound multifocality and axillary nodal status, were collected. The pathologic tumor size, p-multifocality, histologic type, estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, Ki-67, ductal carcinoma in situ (DCIS) and extensive intraductal component (EIC) were also reviewed. The re-excision and BCS success rates were investigated. Univariate analysis and regression model were used. To reduce the effect of selection bias, propensity score matching-based analysis was also performed.
Results: Of the 256 patients, 178 patients (90.4%, 178/197) in the non-neoadjuvant group and 56 patients (94.9%, 56/59) in the neoadjuvant group received BCS (p=0.406). In propensity-matched cohorts (n=118), the re-excision rate was similar in the two groups (35.6% in neoadjuvant group vs. 35.6% in non-neoadjuvant group, p=1.000). BCS success rate was slightly higher in neoadjuvant group (94.9%, 56/59) than in non-neoadjuvant group (86.4% [51/59], p=0.205). In logistic regression model, clinicopathologic factors associated with re-excision were pathologic multifocality (odds ratio [OR], 4.56; p=0.0142), high Ki-67 (≥50%) (OR, 0.7; p=0.0243) and DCIS component (OR, 2.67; p=0.0261).
Conclusion: This study showed that neoadjuvant chemotherapy could increase the success rate of BCS but could not decrease that of re-excision. The re-excision rate is more associated with pathologic finding rather than the effect of neoadjuvant chemotherapy.
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KEYWORD
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Breast neoplasms, Margins of excision, Neoadjuvant chemotherapy, Re-excision, Segmental mastectomy
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