Surgical treatment after neoadjuvant systemic therapy for HER2-positive invasive breast cancer in the Netherlands: 10-Year trends and the influence an accompanying DCIS component.

Autor: Ploumen RAW; Department of Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands; GROW - Research Institute for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, the Netherlands. Electronic address: r.ploumen@maastrichtuniversity.nl., van Nijnatten TJA; GROW - Research Institute for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands., Kooreman LFS; GROW - Research Institute for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, the Netherlands; Department of Pathology, Maastricht University Medical Centre+, Maastricht, the Netherlands., Voogd AC; Department of Epidemiology, Maastricht University, Maastricht, the Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands., Keymeulen KBMI; Department of Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands., Siesling S; Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands; Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, the Netherlands., Smidt ML; Department of Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands; GROW - Research Institute for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, the Netherlands.
Jazyk: angličtina
Zdroj: Breast (Edinburgh, Scotland) [Breast] 2024 Nov 26; Vol. 79, pp. 103854. Date of Electronic Publication: 2024 Nov 26.
DOI: 10.1016/j.breast.2024.103854
Abstrakt: Background: The presence of a DCIS component accompanying invasive breast cancer (IBC) is associated with a higher rate of primary mastectomy compared to IBC without DCIS. After neoadjuvant systemic therapy (NST), HER2+ IBC patients show high response rates, allowing for increasing breast-conserving surgery rates. The aim of this study was to examine surgical trends after NST in a Dutch nationwide HER2+ cohort, and the influence of a DCIS component on mastectomy rate.
Methods: Women with HER2+ IBC, diagnosed between 2010 and 2019 and treated with NST and surgery were included from the Netherlands Cancer Registry. Mastectomy rate was examined over the years, and compared between patients with and without a DCIS component in the pre-NST biopsy. Multivariable logistic regression analysis was used to investigate the association of the DCIS component with mastectomy rate and likelihood of achieving ypT0.
Results: In total, 5289 patients were included. Over 10 years, mastectomy rate significantly decreased from 62.6 % in 2010 to 35.1 % in 2019. Patients with IBC+DCIS more often underwent mastectomy, with a rate of 48.4 % in 2019, compared to 30.0 % in IBC only (p < 0.001). Percentage of ypT0 was significantly lower in patients with IBC+DCIS (38.7 %), compared to IBC only (47.3 %, p < 0.001) Multivariable logistic regression analyses showed presence of DCIS (OR 1.69, 95%CI 1.47-1.95, p < 0.001) to be independently associated with mastectomy.
Conclusion: Rate of mastectomy decreased significantly in HER2+ IBC treated with NST between 2010 and 2019. Presence of DCIS in the biopsy remained associated with higher mastectomy rate, yet 38.7 % of these patients do achieve ypT0.
(Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)
Databáze: MEDLINE
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