Top

Published in:

Open Access 01-06-2017 | Breast Oncology

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

Authors: Jeffrey Landercasper, MD, FACS, Barbara Bennie, PhD, Benjamin M. Parsons, DO, Leah L. Dietrich, MD, Caprice C. Greenberg, MD, MPH, FACS, Lee G. Wilke, MD, FACS, Jared H. Linebarger, MD, FACS

Published in: Annals of Surgical Oncology | Issue 6/2017

Abstract

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.

McCahill LE, Single RM, Aiello Bowles EJ, et al. Variability in reexcision following breast conservation surgery. JAMA. 2012;307:467–75. doi:10.1001/jama.2012.43 CrossRefPubMed

Wilke LG, Czechura T, Wang C, et al. Repeat surgery after breast conservation for the treatment of stage 0 to II breast carcinoma: a report from the National Cancer Database, 2004–2010. JAMA Surg. 2014;149:1296–305. doi:10.1001/jamasurg.2014.926 CrossRefPubMed

Landercasper J, Whitacre E, Degnim AC, Al-Hamadani M. Reasons for re-excision after lumpectomy for breast cancer: insight from the American Society of Breast Surgeons Mastery(SM) database. Ann Surg Oncol. 2014;21:3185–91. doi:10.1245/s10434-014-3905-1 CrossRefPubMed

Jeevan R, Cromwell DA, Trivella M, et al. Reoperation rates after breast-conserving surgery for breast cancer among women in England: retrospective study of hospital episode statistics. BMJ. 2012;345:e4505. doi:10.1136/bmj.e4505 CrossRefPubMedPubMedCentral

Landercasper J, Attai D, Atisha D, et al. Toolbox to reduce lumpectomy reoperations and improve cosmetic outcome in breast cancer patients: the American Society of Breast Surgeons Consensus Conference. Ann Surg Oncol. 2015;22:3174–83. doi:10.1245/s10434-015-4759-x.CrossRefPubMedPubMedCentral

Killelea BK, Yang VQ, Mougalian S, et al. Neoadjuvant chemotherapy for breast cancer increases the rate of breast conservation: results from the National Cancer Database. J Am Coll Surg. 2015;220:1063–9. doi:10.1016/j.jamcollsurg.2015.02.011.CrossRefPubMed

American College of Surgeons. The National Cancer Database, Chicago, IL. Retrieved 1 June 2016 at https://www.facs.org/quality%20programs/cancer/ncdb.

Raval MV, Bilimoria KY, Stewart AK, et al. Using the NCDB for cancer care improvement: an introduction to available quality assessment tools. J Surg Oncol. 2009;99:488–90. doi:10.1002/jso.21173.CrossRefPubMed

Coates AS, Winer EP, Goldhirsch A, et al. Tailoring therapies—improving the management of early breast cancer: St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2015. Ann Oncol. 2015;26:1533–46. doi:10.1093/annonc/mdv221.CrossRefPubMedPubMedCentral

10.

Brouckaert O, Laenen A, Vanderhaegen J, et al. Applying the 2011 St. Gallen panel of prognostic markers on a large single-hospital cohort of consecutively treated primary operable breast cancers. Ann Oncol. 2012;23:2578–84.CrossRefPubMed

11.

Prat A, Cheang MC, Martin M, et al. Prognostic significance of progesterone receptor-positive tumor cells within immunohistochemically defined luminal A breast cancer. J Clin Oncol. 2013;31:203–9. doi:10.1200/JCO.2012.43.4134.CrossRefPubMed

12.

Nielsen TO, Parker JS, Leung S, et al. A comparison of PAM50 intrinsic subtyping with immunohistochemistry and clinical prognostic factors in tamoxifen-treated estrogen receptor-positive breast cancer. Clin Cancer Res. 2010;16:5222–32. doi:10.1158/1078-0432.CCR-10-1282.CrossRefPubMedPubMedCentral

13.

Goldhirsch A, Wood AC, Coates AS, et al. Strategies for subtypes: dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. Ann Oncol. 2011;22:1736–47. doi:10.1093/annonc.mdr304.CrossRefPubMedPubMedCentral

14.

Rakha EA, Reis-Filho JS, Ellis IO. Combinatorial biomarker expression in breast cancer. Breast Cancer Res Treat. 2010;120:293–308. doi:10.1007/s10549-010-0746-x.CrossRefPubMed

15.

Goldhirsch A, Winer EP, Coates AS, et al. Personalizing the treatment of women with early breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2013. Ann Oncol. 2013;24: 2206–23. doi:10.1093/annonc/mdt303.CrossRefPubMedPubMedCentral

16.

Schulman AM, Mirrielees JA, Leverson G, et al. Re-excision surgery for breast cancer: an analysis of the American Society of Breast Surgeons (ASBrS) MasterySM database following the SSO-ASTRO “no ink on tumor” guidelines. Ann Surg Oncol. 2016. doi:10.1245/s10434-016-5516-5.

17.

Isaacs AJ, Gemignani ML, Pusic A, Sedrakyan A. Association of breast conservation surgery for cancer with 90-day reoperation rates in New York State. JAMA Surg. 2016;151:648–55. doi:10.1001/jamasurg.2015.5535.CrossRefPubMed

18.

Boughey JC, Hieken TJ, Jakub JW, et al. Impact of analysis of frozen-section margin on reoperation rates in women undergoing lumpectomy for breast cancer: evaluation of the National Surgical Quality Improvement Program data. Surgery. 2014;156:190–7. doi:10.1016/j.surg.2014.03.025.CrossRefPubMed

19.

Esbona K, Li Z, Wilke LG. Intraoperative imprint cytology and frozen section pathology for margin assessment in breast-conservation surgery: a systematic review. Ann Surg Oncol. 2012;19:3236–45. doi:10.1245/s10434-012-2492-2.CrossRefPubMedPubMedCentral

20.

Pekar G, Hofmeyer S, Tabár L, et al. Multifocal breast cancer documented in large-format histology sections: long-term follow-up results by molecular phenotypes. Cancer. 2013;119:1132–9. doi:10.1002/cncr.27877.CrossRefPubMed

21.

Al-Hilli Z, Thomsen KM, Habermann EB, et al. Reoperation for complications after lumpectomy and mastectomy for breast cancer from the 2012 National Surgical Quality Improvement Program (ACS-NSQIP). Ann Surg Oncol. 2015;22(Suppl 3):S459–69. doi:10.1245/s10434-015-4741-7.CrossRefPubMed

22.

Karanlik H, Ozgur I, Cabioglu N, et al. Preoperative chemotherapy for T2 breast cancer is associated with improved surgical outcome. Eur J Surg Oncol. 2015;41:1226–33. doi:10.1016/j.ejso.2015.06.003.CrossRefPubMed

23.

Waljee JF, Hu ES, Newman LA, et al. Predictors of re-excision among women undergoing breast-conserving surgery for cancer. Ann Surg Oncol. 2008;15:1297–303. doi:10.1245/s10434-007-9777-x.CrossRefPubMed

24.

Volders JH, Haloua MH, Krekel NM, et al. Neoadjuvant chemotherapy in breast-conserving surgery: consequences on margin status and excision volumes: a nationwide pathology study. Eur J Surg Oncol. 2016;42:986–93. doi:10.1016/j.ejso.2016.02.252.CrossRefPubMed

25.

Schwartz T, Degnim AC, Landercasper J. Should re-excision lumpectomy rates be a quality measure in breast-conserving surgery? Ann Surg Oncol. 2013;20:3180–3. doi:10.1245/s10434-013-3206-0.CrossRefPubMed

Title: Fewer Reoperations After Lumpectomy for Breast Cancer with Neoadjuvant Rather than Adjuvant Chemotherapy: A Report from the National Cancer Database
Authors: Jeffrey Landercasper, MD, FACS
Barbara Bennie, PhD
Benjamin M. Parsons, DO
Leah L. Dietrich, MD
Caprice C. Greenberg, MD, MPH, FACS
Lee G. Wilke, MD, FACS
Jared H. Linebarger, MD, FACS
Publication date: 01-06-2017
Publisher: Springer International Publishing
Published in: Annals of Surgical Oncology / Issue 6/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-016-5760-8

At a glance: The STEP trials

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 6/2017

Three Trocars Laparoscopic Total Gastrectomy + D2 Lymphadenectomy with Intracorporeal Manual Esojejunostomy

Metastasis to the Thyroid Gland: A Critical Review

Breast Malignancies in Children: Presentation, Management, and Survival

Clinical and Psychosocial Outcomes of Vascularized Lymph Node Transfer for the Treatment of Upper Extremity Lymphedema After Breast Cancer Therapy

External Validation of a Survival Nomogram for Non-Small Cell Lung Cancer Using the National Cancer Database

Complications in DIEP Flap Breast Reconstruction After Mastectomy for Breast Cancer: A Prospective Cohort Study Comparing Unilateral Versus Bilateral Reconstructions