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Background <p>Neoadjuvant chemotherapy (NAC) is widely used to treat high-risk breast cancer. However, the optimal time to surgery (TTS) following NAC remains undefined. This study investigates the impact of TTS on oncologic outcomes using the I-SPY&#xa0;2 Trial cohort.</p> Methods <p>A retrospective analysis of 1877&#xa0;patients with breast cancer enrolled in the I-SPY&#xa0;2 Trial was performed. Patients were grouped by TTS post-NAC: 1–4&#xa0;weeks, 5&#xa0;weeks, 6–8&#xa0;weeks, and 9 +&#xa0;weeks. Baseline demographic, clinical, imaging, and treatment response data were collected. Event-free survival (EFS) and local recurrence-free interval (LRFI) were evaluated using Kaplan–Meier analyses and Cox models. Subgroup analyses were performed by tumor receptor subtypes (hormone receptor [HR]+ human epidermal growth factor receptor 2 [HER2]−, HER2 +, and triple-negative breast cancer [TNBC])&#xa0;and residual cancer burden (RCB) class.</p> Results <p>Among 1877&#xa0;patients, 526 (28.0%) underwent surgery between 1–4&#xa0;weeks, 425 (22.6%) at 5&#xa0;weeks, 490 (26.1%) between 6–8 weeks, and 436 (23.2%) at 9+ weeks post-NAC. Prolonged TTS was associated with worse 5-year EFS and LRFI on Kaplan–Meier analysis (<i>p</i>&#xa0;&lt;&#xa0;0.001 for both). Delays particularly affected outcomes in patients with HR+/HER2− and TNBC tumors. In patients with RCB class II/III, a TTS of 9+ weeks was independently associated with worse EFS (hazard ratio [HR] 2.04, <i>p</i>&#xa0;=&#xa0;0.001) and LRFI (HR 2.77, <i>p</i>&#xa0;=&#xa0;0.005). Conversely, in patients with a pathologic complete response/RCB class I, delayed surgery did not significantly impact outcomes.</p> Conclusions <p>TTS of 9+ weeks following NAC is independently associated with worse oncologic outcomes, especially in patients with TNBC and HR+/HER2− tumors and high residual disease.</p>

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Impact of Time to Surgery Post Neoadjuvant Chemotherapy on Breast Cancer Outcomes: A Retrospective Study of Patients Enrolled in the I-SPY 2 Clinical Trial

  • 期刊论文

  • 发表日期：

    2025年8月23日

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  • Julie Van Hassel,
  • Katrina Dimitroff,
  • Christina Yau,
  • Rita Mukhtar,
  • Judy C. Boughey,
  • Velle Ladores,
  • Marissa M. Howard-McNatt,
  • Nora Jaskowiak,
  • Jane Perlmutter,
  • Angela DeMichele,
  • Douglas Yee,
  • Nola Hylton,
  • W. Fraser Symmans,
  • Laura van’t Veer,
  • Hope Rugo,
  • Laura J. Esserman,
  • Rebecca Shatsky,
  • Claudine Isaacs,
  • Henry Kuerer,
  • Anne M. Wallace,
  • Nicolas Prionas,
  • Jennifer Tseng,
  • Chantal R. Reyna,
  • Neil Taunk,
  • Susan Kesmodel,
  • Marie C. Lee,
  • Jana Fox,
  • Mara A. Piltin,
  • Julia Tchou,
  • Cletus A. Arciero,
  • Lauren M. Postlewait,
  • Candice Sauder,
  • Roshni Rao

摘要

Background

Neoadjuvant chemotherapy (NAC) is widely used to treat high-risk breast cancer. However, the optimal time to surgery (TTS) following NAC remains undefined. This study investigates the impact of TTS on oncologic outcomes using the I-SPY 2 Trial cohort.

Methods

A retrospective analysis of 1877 patients with breast cancer enrolled in the I-SPY 2 Trial was performed. Patients were grouped by TTS post-NAC: 1–4 weeks, 5 weeks, 6–8 weeks, and 9 + weeks. Baseline demographic, clinical, imaging, and treatment response data were collected. Event-free survival (EFS) and local recurrence-free interval (LRFI) were evaluated using Kaplan–Meier analyses and Cox models. Subgroup analyses were performed by tumor receptor subtypes (hormone receptor [HR]+ human epidermal growth factor receptor 2 [HER2]−, HER2 +, and triple-negative breast cancer [TNBC]) and residual cancer burden (RCB) class.

Results

Among 1877 patients, 526 (28.0%) underwent surgery between 1–4 weeks, 425 (22.6%) at 5 weeks, 490 (26.1%) between 6–8 weeks, and 436 (23.2%) at 9+ weeks post-NAC. Prolonged TTS was associated with worse 5-year EFS and LRFI on Kaplan–Meier analysis (p < 0.001 for both). Delays particularly affected outcomes in patients with HR+/HER2− and TNBC tumors. In patients with RCB class II/III, a TTS of 9+ weeks was independently associated with worse EFS (hazard ratio [HR] 2.04, p = 0.001) and LRFI (HR 2.77, p = 0.005). Conversely, in patients with a pathologic complete response/RCB class I, delayed surgery did not significantly impact outcomes.

Conclusions

TTS of 9+ weeks following NAC is independently associated with worse oncologic outcomes, especially in patients with TNBC and HR+/HER2− tumors and high residual disease.