Local Recurrence after Breast-Conserving Surgery and Mastectomy Following Neoadjuvant Chemotherapy for Locally Advanced Breast Cancer - a Meta-Analysis

Abstract

Background: Breast-conserving surgery (BCS) in patients with large tumors shrunk by neoadjuvant chemotherapy (NCT) remains controversial. We conducted a meta-analysis to evaluate the local recurrence rates in locally advanced breast cancer (LABC) patients receiving NCT comparing BCS with mastectomy.

Methods: Pubmed, Web of Knowledge, and Ovid's database were searched for studies concerning treatment for LABC from January 2000 to June 2015. A meta-analysis was performed to compare the recurrence rates of patients receiving BCS versus mastectomy following NCT.

Results: 8 trials with a total of 3,215 patients were analyzed. The prevalence of local recurrence was 9.2% in the BCS group versus 8.3% in the mastectomy group without significant difference (odds ratio (OR) 1.07, 95% confidence interval (CI) 0.28-1.48; p = 0.66). The 5-year local recurrence-free survival (LRFS) rate was lower in the mastectomy group than in the BCS group, but no significant difference was found between the 2 groups (OR 1.11, 95% CI 0.61-1.99; p = 0.74).

Conclusion: BCS after NCT is safe in terms of local recurrence and LRFS in LABC women. Shrinking tumors with NCT provides the opportunity to apply BCS with no detriment to outcome.

Keywords: Breast-conserving surgery; Locally advanced breast cancer; Mastectomy; Meta-analysis; Neoadjuvant chemotherapy.

Figures

Fig. 1

Flowchart of the results of the literature search.

Fig. 2

Forest plot of the comparison of recurrence rates for BCS vs. mastectomy.

Fig. 3

Forest plot of the comparison of 5-year local recurrence-free survival rates for BCS vs. mastectomy.

Fig. 4

Forest plot of the comparison of 5-year overall survival rates for BCS vs. mastectomy.