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"Doctor, breast cancer surgery has been postponed so much, is it too late?" This analysis clearly answers

 Last Update: 2021-11-03
 Source: Internet
 Author: User

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The outbreak of the new crown epidemic has severely affected the distribution of global health care resources, which inevitably affects the screening and treatment of recently diagnosed breast cancer patients

Standard treatments for patients diagnosed with localized breast cancer include surgery, radiation therapy, and systemic therapy

Although the gold standard for the initial treatment of limited early breast cancer is surgery, in many cases, in addition to suspension of elective and non-emergency surgery, PET may be the first course of choice

This meta-analysis aims to evaluate the efficacy of surgery and primary endocrine therapy (PET) in patients with unprogressive, operable invasive breast cancer, and to determine whether patients with PET as the initial treatment can safely complete delayed surgery

This analysis finally included 6 studies, covering 1499 patients

The characteristics of the included studies are shown in Table 1

Patients receiving PET treatment have a higher risk of local recurrence (HR (95% CI): 1.

Compared with patients undergoing surgery ± PET treatment, patients undergoing PET treatment had a more favorable outcome in terms of overall survival, and there was considerable statistical heterogeneity in the study [HR (95% CI): 1.

3.
All-cause mortality and cancer-specific mortality

All-cause [HR (95% CI): 1.
09 (0.
97, 1.
24); I2 = 76%; p=0.
16] and cancer-specific mortality [HR (95% CI): 1.
11 (0.
91, 1.
36); I2 = 64 %; p=0.
31] There was no significant difference between patients receiving PET treatment and patients receiving surgery ± PET treatment, and there was significant statistical heterogeneity between the studies (Figure 5)
.

4.
Subgroup meta-analysis

In the subgroup meta-analysis, there was no significant difference between the local recurrence rate and the remote recurrence rate
.
Overall [HR (95% CI): 1.
17 (0.
99, 1.
38); I2 = 58%; p=0.
07] and breast cancer-specific survival rate [ HR (95% CI): 1.
13 (0.
96, 1.
33); I2 = 67 %;p=0.
13] There was no significant difference between the two groups
.
Overall [HR (95% CI): 1.
17 (0.
99, 1.
38); I2 = 58%; p=0.
07] and breast cancer-specific survival rate [ HR (95% CI): 1.
13 (0.
96, 1.
33); I2 = 67 %;p=0.
13] HR (95% CI): 1.
13 (0.
96, 1.
33); I2 =67%;p=0.
13] There was no significant difference between the two groups
.
All-cause mortality tends to be surgical ± PET [HR (95% CI): 1.
21 (1.
05, 1.
40); I2 = 0%; p=0.
01], while cancer-specific mortality [HR (95% CI): 1.
21 ( 0.
96, 1.
52); I2 = 65%; p=0.
10] There was no significant difference between the two groups
.

In summary, the main results of this meta-analysis show that PET alone is not as good as surgery ± PET
.
Patients undergoing surgery have a lower risk of local recurrence, higher overall and breast cancer-specific survival rates, and lower cancer-specific mortality and all-cause mortality
.
Although these results support breast cancer patients undergoing surgery early in treatment, these studies also reveal a potential window of time for patients to receive PET treatment to delay surgery
.

Surgery ± PET

How long is too long? In the 6 studies that reported the time to local recurrence, the average time from the initiation of endocrine therapy to local progression was 2.
8 years (range: 1.
1-5.
8 years)
.
Therefore, it is acceptable to use PET therapy alone during the period before undergoing surgery without local recurrence
.
However, the conservative single PET treatment method, avoiding surgery, the time to develop local recurrence is 1.
1 years
.

In the 6 studies that reported the time to local recurrence, the average time from the initiation of endocrine therapy to local progression was 2.
8 years (range: 1.
1-5.
8 years)
.
Therefore, it is acceptable to use PET therapy alone during the period before undergoing surgery without local recurrence
.
However, the conservative single PET treatment method, avoiding surgery, the time to develop local recurrence is 1.
1 years
.

In general, PET alone is not as good as surgery for early invasive breast cancer
.
However, it is acceptable to postpone treatment for breast cancer surgery with no risk of progression by 1.
1 years or more
.
In the future, we need to further study the long-term oncological impact of cancer care interruption during the pandemic, and evaluate the effectiveness and safety of changes in diagnosis and treatment
.

Original source:

Sacha Roberts, et al.
Defer surgery in operable breast cancer: how long is too long?Breast Cancer
https://doi.
org/10.
1007/s12282-021-01302-4

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