Does the Type of Surgery After Preoperative Systemic Therapy for T3/T4 Breast Cancer Impact Survival?
Jamila Alazhri1, Tulay Koru-Sengul2, Feng Miao, Margaret M Byrne and Eli Avisar
Journal Title:Acta Scientific Cancer Biology
Introduction: Our purpose was to study the impact of the extent of surgery on survival of women with T3/T4 breast cancer treated with preoperative systemic therapy (PST) in form of chemotherapy, hormonal therapy, or both. Methods: Population-based Florida Cancer Data Registry was screened for women diagnosed with T3/T4 breast cancer who received PST followed by either breast conserving surgery (BCS) or mastectomy. A multivariable Cox regression model was used to identify significant predictors of overall survival. Adjusted hazard ratio (aHR) and 95% confidence interval (95%CI) were calculated.Results: Out of 712 patients receiving PST, 72 (10%) had BCS and 640 (90%) had mastectomy. After covariable adjustment, patients who received both chemo and hormonal PST had better prognosis than patients with chemotherapy alone (aHR=1.90, 95%CI: 1.20 - 3.01, p = 0.006) or hormonal therapy alone (1.95, 0.84 - 4.56, p = 0.122). Hispanic origin (0.50, 0.27 - 0.92, p = 0.027) positively impacted survival. Medicare (1.70, 1.08 - 2.68, p = 0.021) and uninsured (1.69, 1.10 - 2.60, p = 0.016) compared to private insurance, poorly-differentiated/undifferentiated (2.24, 1.04 - 4.82, p = 0.039) compared to well-differentiated grade, and distant SEER stage (4.13, 1.68 - 10.12, p = 0.002) compared to localized were significant predictors of worse survival. There was no significant difference in survival between women who had mastectomy compared to BCS (1.35, 0.82 - 2.21, p = 0.234). In the subgroup of patients who had mastectomy, radiotherapy resulted in significantly better survival than no radiotherapy (HR 0.68, 0.47-0.99, p = 0.044).Conclusion: The type of surgery after PST for T3/T4 breast cancer does not impact overall survival. BCS could be considered for patients with T3/T4 tumors after PST.