How long is it safe to wait for breast surgery after completion of neoadjuvant chemotherapy?

Abstract

Purpose: This study aimed to evaluate the impact of surgical time on postoperative complications and survival outcomes in breast cancer patients after neoadjuvant chemotherapy (NAC). Patients and Methods: We retrospectively reviewed breast cancer patients treated at Breast Disease Center of the Affiliated Hospital of Qingdao University, from January 2013 to December 2018. The eligibility criteria were female patients with histologically confirmed primary stage II-III breast cancer and initially treated with NAC, who were <75 years old, and patients for whom medical records were available. The patients with severe comorbidities of other organs, with previous histories of other malignancies or breast cancer, and with distant metastasis or contralateral breast cancer, were excluded. Eligible patients were divided into three groups based on time to surgery (TTS): (A) ≤21 days; (B) between 21 and 28 days; and (C) >28 days. We collected medical records and followed up patients. Results: Totally 422 patients were enrolled. The median TTS was 26 days. Among these patients, 119 (28.2%) were in Group A, 152 (36.0%) were in Group B, and 151 (35.8%) were in Group C. Eighty-two (19.4%) patients achieved pathologic complete response (pCR). Survival analysis showed that DFS (P=0.012) and OS (P=0.015) were significantly different among three groups. In multivariate analysis, DFS (HR=2.333, P=0.001) and OS (HR=2.783, P=0.030) were significantly worse when TTS >28 days. Postoperative complications occurred in 96 (22.7%) patients. The incidence of total postoperative complications in the three groups was statistically different (P=0.001) and Group A had worse performance. Multivariate analysis showed that age >50 years old (P=0.004) and TTS ≤21 days (P<0.001) were independent parameters for total postoperative complications.Conclusion: Postoperative complications and survival outcomes in breast cancer patients seemed to be influenced by TTS after the NAC. The benefits were remarkable in patients undergoing surgery between 21 and 28 days.