NESS - Neoadjuvant Chemotherapy for Breast Cancer Increases the Rate of Breast Conservation: Results from the National Cancer Database (NCDB)

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Neoadjuvant Chemotherapy for Breast Cancer Increases the Rate of Breast Conservation: Results from the National Cancer Database (NCDB)
*Brigid K Killelea, *Vicky Q Yang, *Sarah S Mougalian, *Nina R Horowitz, *Lajos Pusztai, Anees B Chagpar, Donald R Lannin
Yale University School of Medicine, New Haven, CT

OBJECTIVES: Neoadjuvant chemotherapy has been shown to increase the rate of breast conservation in clinical trials and small institutional series but has never been studied on a national level.
DESIGN: Retrospective review of national database.
SETTING: The NCDB is a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society and contains about 80% of the cancer cases in the United States.
PATIENTS: All women in the NCDB diagnosed with invasive breast cancer from 2006 through 2011 who underwent definitive breast surgery and received either neoadjuvant or adjuvant chemotherapy, excluding distant metastases or T4 tumors.
OUTCOME MEASURE: rate of breast preservation
RESULTS: Out of 354,204 patients who met the inclusion criteria, 59,063 (16.7%) underwent neoadjuvant chemotherapy. This percent steadily increased from 13.9% in 2006 to 20.5% in 2011 (p<0.001). Receipt of neoadjuvant chemotherapy was associated with larger tumor size (7% cT1, 25% cT2, and 58% cT3, p<0.001), more advanced nodal disease (11% cN0, 39% cN1-3, p<0.001), younger patient age (21% <50 vs. 14% >50, p<0.001), higher tumor grade (18% grade 3, 15% grade 2, vs 12% grade 1, p<0.001), and estrogen receptor negative tumors (21 % ER- vs 15% ER+, p<0.001). Patients with tumors larger than 3 cm. had a higher rate of breast preservation if they received neoadjuvant compared to adjuvant chemotherapy. Multivariate logistic regression showed that when adjusted for the above variables, these patients had a 70% higher odds of receiving lumpectomy with neoadjuvant therapy. (OR 1.7, 95% CI 1.6 to 1.8).
CONCLUSIONS: Neoadjuvant chemotherapy increases breast preservation and should be considered for any patient with a breast cancer larger than 3 cm.

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