Neoadjuvant chemotherapy is not necessarily applicable to patients with LN1-3 positive Luminal-B type operable breast...

The purpose of is to identify the necessity of neoadjuvant chemotherapy in luminal type breast cancer patients (HR-positive HER2-negative) by exploring the treatment characteristics, treatment plan, surgical choice and long-term prognosis between neoadjuvant chemotherapy and adjuvant chemotherapy. A retrospective review of all patients undergoing neoadjuvant chemotherapy at the Fourth Hospital of Hebei Medical University, China, between January 2014 and December 2018 was conducted. These were matched 1:2 by Propensity score matching method (PSM) to patients undergoing adjuvant chemotherapy. Matching variables were common tumor characteristics. Ninety-seven patients received neoadjuvant chemotherapy and 651 patients received adjuvant chemotherapy. After PSM, 79 patients in neoadjuvant chemotherapy group (study group) and 145 patients in adjuvant chemotherapy (control group) were included in the study. Median follow-up was 75 and 60 months for the patients before and after PSM, respectively. The estimated 5-year disease-free survival was 76.4% and 81.1% (P = 0.0208), 5-year overall survival was 77.9% and 88.6% (P = 0.0261) between the neoadjuvant chemotherapy group and adjuvant chemotherapy before PSM. Patients in the adjuvant treatment group had better prognosis. After PSM, the estimated 5-year disease-free survival was 79.4% and 78.3% (P = 0.770), 5-year overall survival was 88.7% and 87.7% (P = 0.400) between the neoadjuvant chemotherapy group and adjuvant chemotherapy. The 7-year update follow up DFS and OS also have no differ significantly between the two groups. It may be reasonable to forego neoadjuvant chemotherapy and prioritize surgical intervention for patients with cN1, high PR expression, Luminal B(HR+/HER2-) breast cancer.