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Peer-reviewedCC BY 4.0Cancers

Survival and Extent of Breast Surgery in Patients with Complete Response After Neoadjuvant Therapy: A Retrospective Analysis from the EUSOMA Database

  • Federica Martorana1,2
  • Damiano Gentile3,4
  • Mariano Tomatis5
  • Antonio Ponti5,6
  • Lorenza Marotti5
  • Cynthia Aristei7,8
  • Nicolò Matteo Luca Battisti9
  • Kwok Leung Cheung10
  • Olaf Johan Hartmann11
  • Isabel T. Rubio12
  • Donatella Santini13
  • Francesco Sardanelli14
5 more authors
  • Elzbieta Senkus15,16
  • Peter van Dam17
  • Giuseppe Curigliano18,19
  • Giuseppe Catanuto2,3
  • on behalf of the EUSOMA Working
19 affiliations
  1. 1Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
  2. 2Humanitas-Istituto Clinico Catanese, Misterbianco, 95045 Catania, Italy
  3. 3Department of Biomedical Sciences, Humanitas University, Rozzano, 20089 Milan, Italy
  4. 4Breast Unit, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
  5. 5European Society of Breast Cancer Specialists (EUSOMA), 50019 Florence, Italy
  6. 6CPO Piemonte, 10123 Turin, Italy
  7. 7Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia, 06156 Perugia, Italy
  8. 8Perugia General Hospital, Sant’Andrea delle Fratte, 06156 Perugia, Italy
  9. 9Breast Unit, Department of Medicine, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
  10. 10Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Nottingham NG7 2UH, UK
  11. 11Akershus University Hospital, 1478 Nordbyhagen, Norway
  12. 12Breast Surgical Oncology, Clinica Universidad de Navarra, Cancer Center Universidad de Navarra, 28027 Madrid, Spain
  13. 13Department of Pathology, IRCCS Policilnico S. Orsola, University of Bologna, 40138 Bologna, Italy
  14. 14Lega Italiana per la Lotta Contro i Tumori (LILT) Milano Monza Brianza, 20133 Milan, Italy
  15. 15Department of Oncology and Radiotherapy, Medical University of Gdańsk, 80-211 Gdańsk, Poland
  16. 16Breast Unit, University Clinical Center, 80-952 Gdańsk, Poland
  17. 17Multidisciplinary Oncologic Center, Antwerp University Hospital, 2650 Edegem, Belgium
  18. 18Department of Oncology and Hemato-Oncology, University of Milano, 20122 Milan, Italy
  19. 19Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, 20141 Milan, Italy
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Abstract

Background: Optimal management of breast cancer (BC) patients with pathological complete response (pCR) after neoadjuvant therapy (NAT) remains debated. We performed a retrospective analysis to evaluate whether the extent of surgery influences survival outcomes in this patient population. Methods: Using the EUSOMA database, we retrospectively collected data of women with pCR after NAT, excluding those with BRCA1/2 mutations. The cohort was stratified by surgery type, i.e., breast-conserving surgery (BCS) or mastectomy. Relapse-free survival (RFS) and overall survival (OS) were compared using Cox regression. Results: Of 467 patients, 327 (70.0%) underwent BCS and 140 (30.0%) underwent mastectomy. Women treated with mastectomy were more likely to have multifocal tumors and advanced disease. After a median follow-up of 5.6 years, 7.3% of patients experienced BC recurrence. Axillary nodal involvement (cN+) and mastectomy were independently associated with recurrence, occurring in 11.4% of cN+ compared to 3.7% of cN0 patients (HR 3.02; 95% CI: 1.40–6.51; p = 0.005) and in 12.5% of mastectomy vs. 5.2% of BCS patients (HR 2.08; 95% CI: 1.05–4.11; p 0.035). cN+ patients also showed significantly higher mortality rates (9.4% vs. 1.6% of cN0; HR 6.16; 95%CI: 2.09–18.17; p= 0.001). However, surgery type did not impact OS. Conclusion: In this cohort of BC patients with pCR after NAT, BCS was not associated with a higher risk of recurrence compared with mastectomy. Baseline nodal involvement independently predicted recurrence and mortality; however, the type of surgery did not impact OS. These findings support BCS as a safe treatment option for this patient population.

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Cite

BibTeXRIS
BibTeX
@article{martorana2026survival,
  title = {{Survival and Extent of Breast Surgery in Patients with Complete Response After Neoadjuvant Therapy: A Retrospective Analysis from the EUSOMA Database}},
  author = {Federica Martorana and Damiano Gentile and Mariano Tomatis and Antonio Ponti and Lorenza Marotti and Cynthia Aristei and Nicolò Matteo Luca Battisti and Kwok Leung Cheung and Olaf Johan Hartmann and Isabel T. Rubio and Donatella Santini and Francesco Sardanelli and Elzbieta Senkus and Peter van Dam and Giuseppe Curigliano and Giuseppe Catanuto and on behalf of the EUSOMA Working},
  journal = {Cancers},
  year = {2026},
  month = nov,
  doi = {10.3390/cancers18213536},
  url = {https://www.mdpi.com/2072-6694/18/21/3536},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Survival and Extent of Breast Surgery in Patients with Complete Response After Neoadjuvant Therapy: A Retrospective Analysis from the EUSOMA Database
AU  - Federica Martorana
AU  - Damiano Gentile
AU  - Mariano Tomatis
AU  - Antonio Ponti
AU  - Lorenza Marotti
AU  - Cynthia Aristei
AU  - Nicolò Matteo Luca Battisti
AU  - Kwok Leung Cheung
AU  - Olaf Johan Hartmann
AU  - Isabel T. Rubio
AU  - Donatella Santini
AU  - Francesco Sardanelli
AU  - Elzbieta Senkus
AU  - Peter van Dam
AU  - Giuseppe Curigliano
AU  - Giuseppe Catanuto
AU  - on behalf of the EUSOMA Working
PY  - 2026
DA  - 2026/11/03
JO  - Cancers
DO  - 10.3390/cancers18213536
UR  - https://www.mdpi.com/2072-6694/18/21/3536
AB  - Background: Optimal management of breast cancer (BC) patients with pathological complete response (pCR) after neoadjuvant therapy (NAT) remains debated. We performed a retrospective analysis to evaluate whether the extent of surgery influences survival outcomes in this patient population. Methods: Using the EUSOMA database, we retrospectively collected data of women with pCR after NAT, excluding those with BRCA1/2 mutations. The cohort was stratified by surgery type, i.e., breast-conserving surgery (BCS) or mastectomy. Relapse-free survival (RFS) and overall survival (OS) were compared using Cox regression. Results: Of 467 patients, 327 (70.0%) underwent BCS and 140 (30.0%) underwent mastectomy. Women treated with mastectomy were more likely to have multifocal tumors and advanced disease. After a median follow-up of 5.6 years, 7.3% of patients experienced BC recurrence. Axillary nodal involvement (cN+) and mastectomy were independently associated with recurrence, occurring in 11.4% of cN+ compared to 3.7% of cN0 patients (HR 3.02; 95% CI: 1.40–6.51; p = 0.005) and in 12.5% of mastectomy vs. 5.2% of BCS patients (HR 2.08; 95% CI: 1.05–4.11; p 0.035). cN+ patients also showed significantly higher mortality rates (9.4% vs. 1.6% of cN0; HR 6.16; 95%CI: 2.09–18.17; p= 0.001). However, surgery type did not impact OS. Conclusion: In this cohort of BC patients with pCR after NAT, BCS was not associated with a higher risk of recurrence compared with mastectomy. Baseline nodal involvement independently predicted recurrence and mortality; however, the type of surgery did not impact OS. These findings support BCS as a safe treatment option for this patient population.
SN  - 2072-6694
ER  -