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Abstract
Introduction. Over the past few decades, the incidence of breast cancer (BC) has been steadily growing. Despite an increase in the detection of early-stage BC, a significant number of newly diagnosed cases are still locally advanced. Approaches to the treatment of these stages have changed considerably. As a result, a comprehensive (trimodal) approach, including the use of neoadjuvant drug therapy in the first stage and local methods (surgery, radiotherapy) in the second stage, has been recognised as the generally accepted standard. At the same time, despite an ever-increasing body of knowledge about the efficacy and safety of surgery, many issues remain unresolved. In particular, the influence of the timing of surgery on the likelihood of complete pathomorphological regression of the tumour and the long-term outcomes of treatment remain unresolved.
Aim. To develop an optimal approach to determining the timing of surgery after completion of neoadjuvant chemotherapy in patients with locally advanced BC.
Materials and Methods. This paper presents a retrospective comparative analysis of the data of patients with locally advanced stage IIIA-IIIC BC who were evaluated and treated at the Research Institute of Clinical Oncology of FSBI N.N. Blokhin NMRCO of the Ministry of Health of Russia from 2000 to 2020. All patients received neoadjuvant chemotherapy and/or endocrine therapy in the first stage, followed by surgical treatment. The paper describes the effect of the timing of surgical treatment on the rate of complete pathological tumor regression in patients with different BC subtypes, as well as on recurrence-free survival and the incidence of surgical complications.
Results. Multivariate analysis showed an independent negative effect of the time interval (> 42 days) before surgical treatment on the probability of complete pathological tumor regression (p = 0.049). Late surgical intervention also reduces recurrence-free survival, primarily in patients with highly aggressive BCs (triple negative, luminal and non-luminal HER2-positive variants, p = 0.026). In addition, surgical interventions performed early (up to 21 days) after completion of neoadjuvant chemotherapy were found to be associated with a significantly increased risk of surgical complications (14.5 %, p = 0.009).
Conclusion. The results of our study allowed us to determine the optimal timing of surgery in patients with locally advanced BC.
References
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