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Long-term outcome for neoadjuvant versus adjuvant chemotherapy in early breast cancer and the prognostic impact of nodal therapy response: A population-based study

  • 0Karolinska Institutet, Oncology/Pathology Department, Stockholm, Sweden.
European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology +

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January 10, 2025

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January 10, 2025

View abstract on PubMed

Summary

This summary is machine-generated.

Neoadjuvant systemic therapy for non-metastatic breast cancer showed no survival benefit over adjuvant treatment. Patients achieving a negative nodal stage after neoadjuvant therapy (cN+/pN0) have an excellent prognosis, suggesting potential for treatment de-escalation.

Area Of Science

  • Oncology
  • Breast Cancer Research
  • Clinical Trial Analysis

Background

  • Neoadjuvant systemic treatment for non-metastatic breast cancer is increasingly used, but its impact on overall survival compared to adjuvant therapy remains debated.
  • The management of axillary lymph nodes in patients responding to neoadjuvant treatment is an evolving area of clinical practice.

Purpose Of The Study

  • To compare the overall survival of patients with non-metastatic breast cancer who received neoadjuvant versus adjuvant systemic therapy.
  • To investigate the prognostic significance of clinical to pathologic nodal stage conversion (cN/pN) in patients undergoing neoadjuvant treatment.

Main Methods

  • Retrospective analysis of a prospectively collected population-based registry from the Stockholm-Gotland region (2007-2020).
  • Inclusion of 2126 patients receiving neoadjuvant chemotherapy and 4754 patients receiving adjuvant chemotherapy.
  • Comparison of overall survival using inverse probability treatment weighting and landmark analysis, with investigation of cN/pN stage changes.

Main Results

  • No significant difference in overall survival was observed between neoadjuvant and adjuvant treatment groups (HR=1.38, p=0.062).
  • Patients who converted from positive clinical to negative pathologic nodal stage (cN+/pN0) demonstrated improved outcomes compared to cN0/pN0 or pN0 after primary surgery.
  • The cN+/pN0 group exhibited a distinct disease trajectory with an early peak in mortality risk followed by a rapid and sustained decline.

Conclusions

  • Neoadjuvant and adjuvant systemic therapies yield similar survival outcomes for non-metastatic breast cancer.
  • Patients with cN+/pN0 status after neoadjuvant treatment have a favorable prognosis, indicating potential for de-escalation of both local and systemic treatments.

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