Breast-conserving surgery is not associated with increased local recurrence in patients with early-stage node-negative triple-negative breast cancer treated with neoadjuvant chemotherapy

• Published in: Breast (Edinburgh) Vol. 74; p. 103701
• Main Authors: Krug, David, Vladimirova, Valentina, Untch, Michael, Kühn, Thorsten, Schneeweiss, Andreas, Denkert, Carsten, Ataseven, Beyhan, Solbach, Christine, Gerber, Bernd, Tesch, Hans, Golatta, Michael, Seiler, Sabine, Heil, Jörg, Nekljudova, Valentina, Holtschmidt, Johannes, Loibl, Sibylle
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.04.2024; Elsevier
• Subjects: Breast Neoplasms - drug therapy; Breast Neoplasms - surgery; Breast-conserving surgery; Disease-Free Survival; Female; Humans; Local recurrence; Mastectomy; Mastectomy, Segmental - adverse effects; Molecular subtype; Neoadjuvant Therapy; Neoplasm Recurrence, Local - pathology; Original; Previous presentation; Primary systemic therapy; Prospective Studies; Recurrence; Retrospective Studies; Triple Negative Breast Neoplasms - surgery; Mastectomy; Molecular subtype; Primary systemic therapy; Local recurrence; Previous presentation; Breast-conserving surgery
• ISSN: 0960-9776; 1532-3080
• DOI: 10.1016/j.breast.2024.103701

Neoadjuvant chemotherapy (NACT) is routinely used for patients with triple-negative breast cancer (TNBC). Upfront breast-conserving therapy (BCT) consisting of breast-conserving surgery (BCS) and adjuvant radiotherapy (RT) has been shown to be associated with improved outcome in patients with early TNBC as compared to mastectomy. We identified 2632 patients with early TNBC from the German Breast Group meta-database. Patients with cT1-2 cN0 and ypN0, available surgery and follow-up data were enrolled. Data of 1074 patients from 8 prospective NACT trials were available. Endpoints of interest were locoregional recurrence as first site of relapse (LRR), disease-free survival (DFS) and overall survival (OS). We performed univariate and multivariate Fine-Gray analysis and Cox regression models. After a median follow-up of 64 months, there were 94 (8.8%) locoregional events as first site of relapse. Absence of pathologic complete response (pCR) was associated with increased LRR upon uni- and multivariate analysis (hazard ratio [HR] = 2.28; p < 0.001 and HR = 2.22; p = 0.001). Type of surgery was not associated with LRR. Patients in the BCS-group had better DFS and OS (DFS: HR = 0.47; p < 0.001 and OS: HR = 0.40; p < 0.001). BCS was associated with improved DFS and OS upon multivariate analysis (DFS: HR = 0.51; p < 0.001; and OS HR = 0.43; p < 0.001), whereas absence of pCR was associated with worse DFS and OS (DFS: HR = 2.43; p < 0.001; and OS: HR = 3.15; p < 0.001). In this retrospective analysis of patients with early stage node-negative TNBC treated with NACT, BCS was not associated with an increased risk of LRR but with superior DFS and OS. •This is an analysis of 1074 patients with early triple-negative breast cancer.•Breast conservation was not associated with increased locoregional recurrence.•Improved overall and disease-free survival was noted with breast conservation.•Patients with pathologic complete response had superior outcome.