A Comprehensive Analysis of Neoadjuvant Chemotherapy in Breast Cancer: Adverse Events, Clinical Response Rates, and Surgical and Pathological Outcomes-Bozyaka Experience

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dc.authoridCakiroglu, Umut/0000-0002-3274-2565
dc.authoridyilmaz, cengiz/0000-0002-7861-5000
dc.authoridZengel, Baha/0000-0002-1812-6846
dc.contributor.authorYilmaz, Cengiz
dc.contributor.authorZengel, Baha
dc.contributor.authorUreyen, Orhan
dc.contributor.authorAdibelli, Zehra Hilal
dc.contributor.authorTasli, Funda
dc.contributor.authorYilmaz, Hasan Taylan
dc.contributor.authorOzdemir, Ozlem
dc.date.accessioned2025-03-20T09:50:32Z
dc.date.available2025-03-20T09:50:32Z
dc.date.issued2025
dc.departmentİzmir Bakırçay Üniversitesi
dc.description.abstractObjectives: To evaluate the neoadjuvant chemotherapy (NACTx) process in breast cancer (BC), its significant treatment-related adverse events (trAEs), tumor clinical response rates, and surgical and pathological outcomes, and to analyze factors influencing cavity shaving and axillary lymph node dissection (ALND) following sentinel lymph node biopsy (SLNB). Methods: A comprehensive retrospective study was conducted at a single center on patients who received NACTx for BC between 2015 and 2021. Results: Medical records of 242 patients were reviewed. Approximately one-fifth encountered grade >= 3 trAEs (21.5%), leading 3.3% to discontinue chemotherapy. Anthracycline cardiotoxicity (2.2%) caused one death (mortality rate = 0.4%). For clinical response and surgical and pathological outcomes, 229 patients were eligible. Clinical progression occurred in 3.9% of the patients (14% in triple-negative BC, p = 0.004). Breast-conserving surgery (BCS) was performed in 55% of the patients. There was no significant difference between the type of breast surgery (BCS vs. mastectomy) and molecular subtype, histology, tumor size, or tumor's pathological response degree. Cavity shaving was required in one-fifth of the patients who underwent BCS (n = 134) due to an invasive tumor at the surgical margin (SM). Tumor histology (invasive ductal vs. invasive lobular carcinoma; OR: 4.962, 95% CI 1.007-24.441, p = 0.049) and tumor SUVMax value (OR: 0.866, 95% CI 0.755-0.993, p = 0.039) had significant independent efficacy on SM positivity. Initially, 75% underwent SLNB, but nearly half of them needed ALND. ALND rates were significantly higher in the luminal A and LB-HER2(-) groups (87% vs. 69%) than in the HER2(+) and TN groups (43% to 50%) (p = 0.001). All luminal A patients and those with lobular histology required ALND after SLNB, but no patients in the HER2-enriched group required ALND. ER positivity and higher PR expression levels were associated with an increased need for ALND after SLNB, whereas HER2 positivity and higher SUVMax values of LN(s) were associated with a significantly reduced need for ALND. About 27% of the patients achieved overall pCR. No pCR was achieved in the LA group. Conclusions: The BC NACTx process requires close monitoring due to severe AEs and disease progression. NACTx decisions must be made on experienced multidisciplinary tumor boards, considering tumor characteristics and expected targets.
dc.identifier.doi10.3390/cancers17020163
dc.identifier.issn2072-6694
dc.identifier.issue2
dc.identifier.pmid39857945
dc.identifier.scopus2-s2.0-85216086377
dc.identifier.scopusqualityQ1
dc.identifier.urihttps://doi.org/10.3390/cancers17020163
dc.identifier.urihttps://hdl.handle.net/20.500.14034/2243
dc.identifier.volume17
dc.identifier.wosWOS:001403777500001
dc.identifier.wosqualityQ1
dc.indekslendigikaynakWeb of Science
dc.indekslendigikaynakScopus
dc.indekslendigikaynakPubMed
dc.language.isoen
dc.publisherMDPI
dc.relation.ispartofCancers
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanı
dc.rightsinfo:eu-repo/semantics/closedAccess
dc.snmzKA_WOS_20250319
dc.subjectbreast cancer
dc.subjectmolecular subtypes
dc.subjectneoadjuvant chemotherapy
dc.subjectadverse events
dc.subjectclinical progression
dc.subjectsurgical outcomes
dc.subjectcavity shaving
dc.subjectpathological outcomes
dc.titleA Comprehensive Analysis of Neoadjuvant Chemotherapy in Breast Cancer: Adverse Events, Clinical Response Rates, and Surgical and Pathological Outcomes-Bozyaka Experience
dc.typeArticle

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