Background: Neoadjuvant therapy (NAT) has become increasingly employed for the treatment of cT3-4 breast cancer (BC), enabling breast-conserving surgery (BCS) in cases traditionally considered for mastectomy. This study aims to identify predictors for breast conservation post-NAT and to evaluate whether BCS influences long-term oncological outcomes. Methods: We retrospectively analyzed data from patients with cT3-4 BC who received NAT at the Breast Unit of IRCCS Humanitas Research Hospital, Milan, Italy, from October 2009 to April 2020. Surgical outcomes and long-term oncological results, such as disease-free survival (DFS), distant DFS (DDFS), overall survival (OS), and BC-specific survival (BCSS), were compared between the BCS and mastectomy groups. Results: Among 114 patients analyzed, 37 (32.5%) underwent BCS, and 77 (67.5%) had a mastectomy. The key predictors for opting for BCS included absence of vascular invasion, reduced tumor size post-NAT, and achieving ypT0 status. No significant differences in DFS, DDFS, OS, and BCSS were observed between the two surgical groups (log-ranks,p= 0.520,p= 0.789,p= 0.216,p= 0.559, respectively). Conclusions: BCS after NAT is a feasible and safe option for patients with cT3-4 BC, without adversely affecting long-term oncological outcomes. Identifying predictors of breast conservation can guide surgical decision-making, ensuring that patients receive optimal treatment.
背景：新辅助治疗（NAT）在cT3-4期乳腺癌（BC）治疗中的应用日益广泛，使得传统需行乳房切除术的患者得以接受保乳手术（BCS）。本研究旨在识别NAT后保乳手术的预测因素，并评估BCS是否影响长期肿瘤学结局。方法：我们回顾性分析了2009年10月至2020年4月在意大利米兰IRCCS Humanitas研究医院乳腺中心接受NAT的cT3-4期BC患者数据。比较了BCS组与乳房切除术组的手术结果及长期肿瘤学结局，包括无病生存期（DFS）、远处无病生存期（DDFS）、总生存期（OS）和乳腺癌特异性生存期（BCSS）。结果：在分析的114例患者中，37例（32.5%）接受了BCS，77例（67.5%）接受了乳房切除术。选择BCS的关键预测因素包括无血管侵犯、NAT后肿瘤体积缩小以及达到ypT0状态。两组手术患者在DFS、DDFS、OS和BCSS方面均未观察到显著差异（对数秩检验p值分别为0.520、0.789、0.216、0.559）。结论：对于cT3-4期BC患者，NAT后行BCS是一种可行且安全的选择，且不影响长期肿瘤学结局。识别保乳手术的预测因素可指导手术决策，确保患者获得最佳治疗。
肿瘤(癌症)患者之家