Fewer Reoperations After Lumpectomy for Breast Cancer with Neoadjuvant Rather than Adjuvant Chemotherapy: A Report from the National Cancer Database

• Published in: Annals of surgical oncology Vol. 24; no. 6; pp. 1507 - 1515
• Main Authors: Landercasper, Jeffrey, Bennie, Barbara, Parsons, Benjamin M., Dietrich, Leah L., Greenberg, Caprice C., Wilke, Lee G., Linebarger, Jared H.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.06.2017; Springer Nature B.V
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Breast cancer; Breast Neoplasms - drug therapy; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Breast Oncology; Chemotherapy; Chemotherapy, Adjuvant - utilization; Databases, Factual; Female; Follow-Up Studies; Humans; Lumpectomy; Mastectomy; Medicine; Medicine & Public Health; Middle Aged; Neoadjuvant Therapy - utilization; Oncology; Prognosis; Reoperation - statistics & numerical data; Second-Look Surgery - statistics & numerical data; Surgery; Surgical Oncology; Survival Rate; Young Adult; Propensity Score; Breast Cancer Subtype; Propensity Score Match; Reoperation Rate; Breast Cancer
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-016-5760-8

Background Reoperations occur frequently after initial lumpectomy for breast cancer. The authors hypothesized that the receipt of neoadjuvant chemotherapy (NAC) is associated with fewer reoperations. Methods The association between timing of chemotherapy and reoperation rates (ROR) after lumpectomy was investigated for patients with stages 1–3 breast cancer in the National Cancer Database (NCDB) from 2010 to 2013 by multivariable logistic regression modeling. Then propensity score-matching was performed. Results The unadjusted ROR for 71,627 stages 1–3 patients was 11.4% for those who had NAC compared with 20.3% for those who had postoperative chemotherapy ( p < 0.001) (odds ratio [OR] 0.53; 95% confidence interval [CI] 0.49–0.57; p < 0.001). The ORs for the reoperations performed for patients with stages 1, 2, and 3 cancers who received NAC were respectively 0.65 (95% CI 0.56–0.75), 0.50 (95% CI 0.45–0.56), and 0.27 (95% CI 0.19–0.38) The p values for all were lower than 0.001. Conclusion For a population of patients receiving chemotherapy, the receipt of chemotherapy before instead of after surgery was associated with fewer reoperations after initial lumpectomy for breast cancer.