Predictors of Surgical Decision-Making After Neoadjuvant Chemotherapy for Breast Cancer

Following neoadjuvant chemotherapy (NAC), a subset of breast cancer patients becomes candidates for breast conserving surgery (BCS) after tumor downstaging. In the literature, there is little analysis of patient choice after NAC. The goal of this study is to investigate clinical and demographic predictors of patients' surgical choices after NAC to better inform shared decision-making.

A retrospective chart review was conducted on breast cancer patients at our institution who became BCS candidates after receiving NAC from January 1, 2010 to September 30, 2020. Patient demographics, clinical characteristics, choice of mastectomy vs. BCS, and outcomes were compared. Exclusion criteria included inflammatory, recurrent, bilateral breast cancers, and patients with genetic predisposition. Statistical analysis utilized R software version 4.2.3 with a significance threshold P < .05.

In total, 244 patients met study criteria, of which 181 patients (74.2%) chose BCS, and 63 patients (25.8%) elected mastectomy. On average, mastectomy patients were younger at the time of diagnosis than BCS patients (48 vs. 53 years old, P = .003). Although breast tumor palpability was not associated with choice of surgery (P = .271), palpable axillary lymphadenopathy was associated with a higher likelihood of choosing mastectomy (44.4% vs. 29.3%, P = .041). Patient race, pretreatment clinical stage, and doxorubicin-based chemotherapy were not associated with patients' decisions for type of surgery.

Most breast cancer patients elect BCS after downstaging from NAC. Factors that may predict choosing mastectomy include younger age at diagnosis and pretreatment palpable axillary lymphadenopathy. These considerations should be integrated into shared surgical decision-making after NAC.