Survival and Extent of Breast Surgery in Patients with Complete Response After Neoadjuvant Therapy: A Retrospective Analysis from the EUSOMA Database

ABSTRACTBackground: The optimal management of breast cancer (BC) patients with pathological complete response (pCR) following neoadjuvant therapy (NAT) remains debated. We performed a retrospective analysis to evaluate whether the extent of surgery influences survival outcomes in this patient population.Materials and Methods: Using the EUSOMA database, we retrospectively collected data of women with pCR after NAT, excluding those with BRCA1/2 mutations. The cohort was stratified by surgery type, i.e. breast-conserving surgery (BCS) or mastectomy. Relapse-free survival (RFS) and overall survival (OS) were compared using Cox regression.Results: Of 467 patients, 327 (70%) underwent BCS and 140 (30%) mastectomy. Women treated with mastectomy were more likely to have multifocal tumors and advanced disease. After a median follow-up of 5.6 years, 7.3% of patients experienced BC recurrence. Axillary nodal involvement (cN+) and mastectomy were independently associated with recurrence, occurring in 11.4% of cN+ compared to 3.7% of cN0 patients (HR 3.02; 95% CI: 1.40-6.51; p=0.005), and in 12.5% of mastectomy vs 5.2% of BCS patients (HR 2.08; 95% CI: 1.05-4.11; p 0.035). cN+ patients also showed significantly higher mortality rates (9.4% vs 1.6% of cN0; HR 6.16; 95%CI: 2.09-18.17; p= 0.001). However, surgery type did not impact OS.Conclusion: In this large cohort of BC patients with pCR after NAT, mastectomy was associated with a higher risk of recurrence compared with BCS. Baseline nodal involvement independently predicted recurrence and mortality; however, the type of surgery did not impact OS. These findings support BCS as a safe treatment option for this patient population.

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Journal
Cancers
Published
2026-11-03
DOI
https://doi.org/10.3390/cancers18213536
Primary Topic
Breast Cancer Treatment Studies
Type
article
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article

Survival and Extent of Breast Surgery in Patients with Complete Response After Neoadjuvant Therapy: A Retrospective Analysis from the EUSOMA Database

Giuseppe Curigliano, Peter A. van Dam, Giuseppe Catanuto, Kwok‐Leung Cheung et al.
4 links
Cancers
Breast Cancer Treatment Studies
article

Survival and Extent of Breast Surgery in Patients with Complete Response After Neoadjuvant Therapy: A Retrospective Analysis from the EUSOMA Database

Giuseppe Curigliano, Peter A. van Dam, Giuseppe Catanuto, Kwok‐Leung Cheung, Antonio Ponti, Francesco Sardanelli, Nicolò Matteo Luca Battisti, Federica Martorana, Isabel Teresa Rubio, Elżbieta Senkus, Donatella Santini, Olaf Johan Hartmann-Johnsen, Damiano Gentile, Lorenza Marotti, cynthia aristei, Mariano Tomatis, on behalf of the EUSOMA Working
article en

Abstract

ABSTRACTBackground: The optimal management of breast cancer (BC) patients with pathological complete response (pCR) following neoadjuvant therapy (NAT) remains debated. We performed a retrospective analysis to evaluate whether the extent of surgery influences survival outcomes in this patient population.Materials and Methods: Using the EUSOMA database, we retrospectively collected data of women with pCR after NAT, excluding those with BRCA1/2 mutations. The cohort was stratified by surgery type, i.e. breast-conserving surgery (BCS) or mastectomy. Relapse-free survival (RFS) and overall survival (OS) were compared using Cox regression.Results: Of 467 patients, 327 (70%) underwent BCS and 140 (30%) mastectomy. Women treated with mastectomy were more likely to have multifocal tumors and advanced disease. After a median follow-up of 5.6 years, 7.3% of patients experienced BC recurrence. Axillary nodal involvement (cN+) and mastectomy were independently associated with recurrence, occurring in 11.4% of cN+ compared to 3.7% of cN0 patients (HR 3.02; 95% CI: 1.40-6.51; p=0.005), and in 12.5% of mastectomy vs 5.2% of BCS patients (HR 2.08; 95% CI: 1.05-4.11; p 0.035). cN+ patients also showed significantly higher mortality rates (9.4% vs 1.6% of cN0; HR 6.16; 95%CI: 2.09-18.17; p= 0.001). However, surgery type did not impact OS.Conclusion: In this large cohort of BC patients with pCR after NAT, mastectomy was associated with a higher risk of recurrence compared with BCS. Baseline nodal involvement independently predicted recurrence and mortality; however, the type of surgery did not impact OS. These findings support BCS as a safe treatment option for this patient population.

CancersVol. 18(21)
Royal Marsden NHS Foundation Trust (GB), Humanitas University (IT), University of Nottingham (GB), University of Milan (IT), University of Perugia (IT), Royal Derby Hospital (GB), Akershus University Hospital (NO), University of Catania (IT), University of Gdańsk (PL), Azienda Ospedaliera di Perugia (IT), IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola (IT), Antwerp University Hospital (BE), Royal Marsden Hospital (GB), Lega Italiana per la Lotta ai Tumori (IT), University Clinical Centre (PL), Clinica Universidad de Navarra (ES), Piedmont Reference Center for Epidemiology and Cancer Prevention (IT), IRCCS Humanitas Research Hospital (IT), European Institute of Oncology (IT), Gdańsk Medical University (PL), University of Bologna (IT)
Good health and well-being
Openalex Percentile: Top 98%
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