An Innovative Scoring System to Select the Optimal Surgery in Breast Cancer after Neoadjuvant Chemotherapy
Abstract
:1. Introduction
2. Materials and Methods
2.1. Operative Protocol, Surgical Technique, and Pathological Evaluation
2.2. Adjuvant Treatment
2.3. Statistical Analysis and Score Processing
2.4. Evaluation of Oncological, Aesthetic Outcomes, and Patient Quality of Life (QoL)
2.5. Assessment of the Adherence of Score with Type of Surgery
3. Results
3.1. Demographic, Clinical, and Biological Features
3.2. Pre- and Post-NACT Radiological Assessment
3.3. Pathological Response
3.4. Adjuvant Treatments
3.5. Outcomes According to the Type of Surgery
3.6. Definition of “pNESSy”
3.6.1. Univariate and Multivariable Analysis for BCS (Table S3)
3.6.2. Univariate and Multivariable Analysis for OPS (Table S4)
3.6.3. Univariate and Multivariable Analysis for CMR (Table S5)
3.7. Assessment of pNESSy Adherence with Surgery and Evaluation of Outcomes
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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BCS 118 (46.3%) | OPS 49 (19.2%) | CMR 88 (34.5%) | p-Value | |
---|---|---|---|---|
Demographic characteristics | ||||
Age (y) | 51.9 ± 11.5 (44.2–60.3) | 48.3 ± 9.1 (42.2–53) | 45. 8 ± 9.7 (39.6–52.4) | p < 0.0001 |
BMI (kg/m2) | 25.4 ± 4.7 (22.7–27.3) | 27.4 ± 5.3 (23.3–30.1) | 23.2 ± 3.5 (20.8–24.5) | p < 0.0001 |
Menopausal status
| 58 (49.2%) 60 (50.8%9 | 19 (38.8%) 30 (61.2%) | 24 (27.3%) 64 (72.7%) | p = 0.006 |
Pathological mutations of BRCA 1 or 2 | 5 (4.2%) | 1 (2%) | 18 (20.5%) | p < 0.0001 |
Anatomic-morphological mammary characteristics of breasts | ||||
Bra size
| 26 (22.0%) 50 (42.4%) 42 (35.6%) | 8 (16.3%) 13 (26.5%) 28 (57.2%) | 8 (44.4%) 30 (34.1%) 19 (21.5%) | p < 0.0001 |
Ptosis
| 20 (16.9%) 53 (44.9%) 45 (38.2%) | 5 (10.2%) 13 (26.5%) 31 (63.3%) | 44 (50%) 30 (34.1%) 14 (15.9%) | p < 0.0001 |
Location of cancer | ||||
| 78 (66.1%) 8 (6.8%) 4 (3.4%) 20 (16.9%) 8 (6.8%) | 36 (73.5%) 4 (8.2%) 1 (2%) 6 (12.2%) 2 (4.1%) | 65 (73.9%) 7 (8%) 2 (2.3%) 11 (12.5%) 3 (3.4%) | p = 0.948 |
Biological characteristics of cancer | ||||
Histotype
| 86 (72.9%) 8 (6.8%) 24 (20.3%) | 35 (71.5%) 3 (6.1%) 11 (22.4%) | 63 (71.6%) 6 (6.8%) 19 (21.6%) | p = 0.997 |
Grading
| 0 (0%) 33 (28%) 85 (72%) | 0 (0%) 15 (30.6%) 34 (69.4%) | 1 (1.1%) 24 (27.3%) 63 (71.6%) | p = 0.830 |
Immunophenotype
| 59 (50%) 39 (33.1%) 20 (16.9%) | 22 (44.9%) 16 (32.7%) 11 (22.4%) | 38 (43.2%) 31 (35.2%) 19 (21.6%) | p = 0.825 |
Initial stage of cancer ** | ||||
| 6 (5.1%) 32 (27.1%) 40 (33.9%) 29 (24.6%) 7 (5.9%) 4 (3.4%) | 1 (8.3%) 9 (18.4%) 18 (36.7%) 18 (36.7%) 2 (4.1%) 1 (20%) | 5 (5.7%) 24 (27.3%) 26 (29.5%) 24 (27.3%) 6 (6.8%) 3 (3.4%) | p = 0.904 |
BCS 118 (46.3%) | OPS 49 (19.2%) | CMR 88 (34.5%) | p-Value | |
---|---|---|---|---|
Assessment Pre-NACT | ||||
Rancati score
| 31 (26.3%) 64 (54.2%) 23 (19.5%) | 8 (16.3%) 30 (61.3%) 11 (22.4%) | 39 (44.3%) 43 (48.9%) 6 (6.8%) | p = 0.001 |
Breast volume (cm3) *
| 33 (28%) 53 (44.9%) 32 (27.1%) | 5 (10.2%) 16 (32.7%) 28 (57.1%) | 53 (60.2%) 24 (27.3%) 11 (12.5%) | p < 0.0001 |
Microcalcification extension
| 90 (76.3%) 27 (22.9%) 1 (0.8%) | 20 (40.8%) 26 (53.1%) 3 (6.1%) | 42 (47.7%) 36 (40.9%) 10 (10.4%) | p < 0.0001 |
No. involved quadrants
| 77 (65.3%) 31 (26.3%) 10 (8.5%) | 17 (34.7%) 16 (32.7%) 16 (32.7%) | 29 (33.0%) 18 (20.5%) 41 (46.6%) | p < 0.0001 |
Pre-NACT RX-PEBA
| 71 (60.2%) 33 (28.1%) 14 (11.7%) | 14 (28.6%) 30 (61.2%) 5 (10.2%) | 20 (22.7%) 12 (13.6%) 56 (63.7%) | p < 0.0001 |
Pre-NACT focality
| 84 (71.2%) 27 (22.9%) 7 (5.9%) | 12 (24.5%) 34 (69.4%) 3 (6.1%) | 28 (31.8%) 17 (19.3%) 43 (48.9%) | p < 0.0001 |
Pre-NACT MRI-PEBA
| 74 (62.7%) 38 (32.2%) 6 (5.1%) | 10 (20.4%) 33 (67.4%) 6 (12.2%) | 19 (21.6%) 30 (34.1%) 39 (44.3%) | p < 0.0001 |
Assessment post-NACT | ||||
Radiological response
| 66 (55.9%) 38 (32.3%) 12 (10.2%) 2 (1.7%) | 16 (32.7%) 29 (59.2%) 4 (8.2%) 0 (0%) | 38 (43.2%) 33 (37.5%) 16 (18.2%) 1 (1.1%) | p = 0.016 |
Post-NACT RX-PEBA
| 87 (73.7%) 27 (22.9%) 4 (3.4%) | 14 (28.6%) 35 (71.4%) 0 (0%) | 27 (30.7%) 40 (45.5%) 21 (9.8%) | p < 0.0001 |
Post-NACT focality
| 65 (55.1%) 42 (35.6%) 9 (7.6%) 2 (1.7%) | 15 (30.6%) 12 (23.9%) 20 (40.8%) 2 (4.1%) | 36 (40.9%) 21 (23.9%) 6 (6.8%) 25 (28.4%) | p < 0.0001 |
Post-NACT MRI-PEBA
| 75 (63.6%) 36 (30.5%) 7 (5.9%) | 14 (28.6%) 24 (49%) 11 (22.4%) | 39 (44.3%) 16 (18.2%) 33 (37.5%) | p < 0.0001 |
BRCA 1 or 2 Genes | No Pathogenetic Variant | Pathological Mutation | |
---|---|---|---|
0 | 2.867 | ||
Ptosis | Grade 0 | Grade 1 | Grade 2 or 3 |
1.389 | 0.511 | 1.352 | |
Breast volume evaluated with MRI | <645.99 cm3 | 646.00–1009.39 cm3 | >1009.4 cm3 |
1.375 | 0.900 | 1.526 | |
Pre-NACT Focality | Unifocality | Multifocality | Multicentricity |
1.368 | 1.193 | 2.309 | |
Pre-NACT MRI-PEBA | <3.52 | 3.53–9.99 | >10.00 |
1.251 | 1.391 | 1.860 | |
Post-NACT Focality | Clinical complete response or unifocal | Multifocality | Multicentricity |
1.536 | 2.274 | 2.007 | |
Post-NACT RX-PEBA | <0.041 | 0.042–4.61 | >4.62 |
1.505 | 2.020 | 1.589 | |
SCORE | 6.896–8.724 | 8.725–9.375 | 9.376–14.245 |
p < 0.0001 | p < 0.0001 | p < 0.0001 | |
TYPE OF SURGERY | BCS | OPS | CMR |
G1 164 (64.3%) | G2 91 (35.7%) | p-Value | |
---|---|---|---|
Oncological radicality | |||
Reached Failed | 152 (95%) 8 (5%) | 81 (85.3%) 14 (14.7%) | p = 0.010 |
Aesthetic Outcomes evaluate on patients who responded to “Breast Q” questionnaire * | |||
G1 123 (75%) | G2 69 (75.8%) | ||
Q1. Satisfaction with breasts <40 41–70 >71 | 29 (23.6%) 45 (36.6%) 49 (39.8%) | 30 (43.5%) 20 (29.0%) 19 (27.5%) | p = 0.017 |
Q2. Psychological wellbeing <40 41–70 >71 | 21 (17.1%) 37 (30.1%) 65 (52.8%) | 18 (26.5%) 21 (30.9%) 29 (49.2%) | p = 0.245 |
Q3. Sexual wellbeing <40 41–70 >71 | 37 (30.1%) 46 (37.4%) 40 (32.5%) | 31 (45.6%) 19 (27.9%) 18 (26.5%) | p = 0.108 |
Q4. Physical wellbeing: chest <40 41–70 >71 | 77 (62.6%) 38 (30.9%) 8 (6.5%) | 35 (51.5%) 15 (22.1%) 18 (26.5%) | p = 0.001 |
Breast sensitivity Preserved Lost | 49 (39.8%) 74 (60.2%) | 22 (32.4%) 46 (67.6%) | p = 0.350 |
Evaluation in patients with loss of breast sensitivity ** | |||
G1 76 (61.7%) | G2 44 (63.7%) | ||
Percentage of breast sensitivity lost 10–30% 40–70% 70–100% | 35 (46.1%) 25 (32.9%) 16 (21.1%) | 23 (52.3%) 13 (29.5%) 8 (18.2%) | p = 0.825 |
Influence on daily life 0–30% 40–70% 70–100% | 35 (46.1%) 25 (32.9%) 16 (21.1%) | 23 (52.3%) 13 (29.5%) 8 (18.2%) | p = 0.825 |
Influence on sexual life 0–30% 40–70% 70–100% | 23 (30.3%) 23 (30.3%) 30 (39.5%) | 17 (38.6%) 13 (29.5%) 14 (31.8%) | p = 0.607 |
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Franco, A.; Di Leone, A.; Conti, M.; Fabi, A.; Carbognin, L.; Terribile, A.D.; Belli, P.; Orlandi, A.; Sanchez, M.A.; Moschella, F.; et al. An Innovative Scoring System to Select the Optimal Surgery in Breast Cancer after Neoadjuvant Chemotherapy. J. Pers. Med. 2023, 13, 1280. https://doi.org/10.3390/jpm13081280
Franco A, Di Leone A, Conti M, Fabi A, Carbognin L, Terribile AD, Belli P, Orlandi A, Sanchez MA, Moschella F, et al. An Innovative Scoring System to Select the Optimal Surgery in Breast Cancer after Neoadjuvant Chemotherapy. Journal of Personalized Medicine. 2023; 13(8):1280. https://doi.org/10.3390/jpm13081280
Chicago/Turabian StyleFranco, Antonio, Alba Di Leone, Marco Conti, Alessandra Fabi, Luisa Carbognin, Andreina Daniela Terribile, Paolo Belli, Armando Orlandi, Martin Alejandro Sanchez, Francesca Moschella, and et al. 2023. "An Innovative Scoring System to Select the Optimal Surgery in Breast Cancer after Neoadjuvant Chemotherapy" Journal of Personalized Medicine 13, no. 8: 1280. https://doi.org/10.3390/jpm13081280