Optimal timing of surgery following breast cancer neoadjuvant chemotherapy: A systematic review and meta-analysis |
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| Affiliation: | 1. Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Cardiothoracic Surgery, Postbus 9101, 6500, HB Nijmegen, the Netherlands;2. Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333, AA Leiden, the Netherlands;3. Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Department of Surgery, Plesmanlaan 121, 1066, CX Amsterdam, the Netherlands;4. Amsterdam University Medical Center, Department of Surgery, Postbus 7057, 1008 MB Amsterdam, the Netherlands;5. Amsterdam University Medical Center, Department of Cardiothoracic Surgery, Postbus 7057, 1008, MB Amsterdam, the Netherlands;1. Department of Surgery, Amsterdam UMC, University of Amsterdam, the Netherlands;2. Cancer Center Amsterdam, Amsterdam, the Netherlands;3. ENETS Center of Excellence, Amsterdam UMC, University of Amsterdam, the Netherlands;4. Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands;1. Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China;2. Department of Gastric Surgery, Liaoning Cancer Hospital and Institute, Cancer Hospital of China Medical University, Shenyang, China;3. Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China;4. Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China;5. Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union College, Beijing, China;6. Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi’an, China;7. Department of Gastrointestinal Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China;8. Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China;9. Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China;10. Department of Gastrointestinal Surgery, Peking University People’s Hospital, Beijing, China;11. Department of General Surgery, the First Affiliated Hospital of Shandong First Medical University, Jinan, China;1. Leiden University Medical Center, Department of Surgery, Albinusdreef 2, Postbus 9600, 2300, RC Leiden, the Netherlands;2. Netherlands Comprehensive Cancer Organization, Department of Research and Development, Godebaldkwartier 419, Postbus 19079, 3501, DB Utrecht, the Netherlands;3. Belgian Cancer Registry, Koningsstraat 215 Bus 7, 1210, Brussels, Belgium;4. Oslo University Hospital, Department of Oncology and K.G. Jebsen Colorectal Cancer Research Centre, PO 4953, Nydalen, Oslo, Norway;5. Stavanger University Hospital, Stavanger, Department of Gastrointestinal Surgery, Postboks 8100, 4068, Stavanger, Norway;6. University of Bergen, Department of Clinical Medicine, Jonas Lies Veg 87, N-5021, Bergen, Norway;7. Karolinska Institutet, Department of Molecular Medicine and Surgery, Solnavägen 1, 171 77, Stockholm, Sweden;8. Umeå University, The Biobank Research Unit, 901 87, Umeå, Sweden;9. Reinier de Graaf Hospital, Department of Surgery, Reinier de Graafweg 5, Postbus 5011, 2600, GA Delft, the Netherlands |
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| Abstract: | BackgroundAdministration of chemotherapy before breast surgery has the potential to reduce the risk of distant recurrence by targeting micrometastasis as well as allowing a more minimalistic approach to surgical intervention. We performed a systematic review to determine the optimum timing of surgery post breast cancer neoadjuvant chemotherapy (NACT).MethodsThe primary outcome was to determine whether the timing of surgery post NACT impacted overall survival (OS) and disease-free survival (DFS). We compared patient outcomes between those who had surgery within 8 weeks of completion of NACT to those that had surgery after 8 weeks. An outcome comparison between <4 weeks and 4–8 weeks was also performed. Secondary outcome included complete pathological response (pCR) post NACT. A meta-analysis was performed using the Mantel-Haenszel method.ResultsFive studies, including 8794 patients were eligible for inclusion. Patients that had surgery within 8 weeks of completion of NACT had a statistically significant improved OS(OR 0.47, 95% c. i 0.34–0.65) and DFS(OR 0.71 (95% c. i 0.52–0.98, P = 0.04). There were no survival advantages associated with having surgery less than 4 weeks post completion of NACT (OR 0.78, 95% c. i 0.46–1.33, P = 0.37). There was no difference in pCR rate between those that had surgery <4 weeks and 4–8 weeks (OR 1.01, 95% c. i 0.80–1.28, P = 0.93).ConclusionThis meta-analysis shows that the optimum timing of surgery post completion of NACT is 4–8 weeks as it is associated with increased OS and DFS. |
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| Keywords: | Breast cancer Neoadjuvant chemotherapy Surgery |
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