title: Impact of time to surgery after neoadjuvant chemotherapy in operable breast cancer patients.
abstract: BACKGROUND
  The optimal time interval between the end of neoadjuvant systemic therapy (NST) and breast surgery is still unclear. It is not known if a delay in surgery might influence the benefit of primary chemotherapy. The aim of this study is to evaluate the relationship between time to surgery (TTS) and survival outcomes.
  
  
  METHODS
  According to TTS, women with diagnosis of BC treated with NST were divided into two cohorts: group A = 21 days or fewer and group B = longer than 21 days. OS and RFS were estimated and compared according to TTS and known prognostic factors.
  
  
  RESULTS
  A total of 319 patients were included in the study: 61 in group A and 258 in group B. Median TTS was 34 days. No association between clinical stage, nuclear grade, type of chemotherapy, type of surgery and TTS was detected. OS and RFS were significantly worse for group B compared with group A, with a hazard ratio of 3.1 (95% CI, 1.1-8.6 p = 0.03) and 3.1 (95% CI, 1.3-7.1 p = 0.008) respectively. Multivariate analysis confirmed that TTS was an independent prognostic factor in term of OS (p = 0.03) and RFS (p = 0.01). Even in the subgroup of patients with pCR, TTS continued to be an independent prognostic factor for both OS and RFS (p = 0.05 and p = 0.03).
  
  
  CONCLUSIONS
  TTS after NST seems to influence survival outcomes. BC patients underwent surgery within 21 days experienced maximal benefit from previous treatment: this advantage is consistent and maintained over time.
authors: Division of Medical Oncology, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Via del Pozzo 71, 41122 Modena, Italy. Electronic address: claudia.omarini@gmail.com.
authors: C
authors: C
authors: Omarini
authors: Division of Medical Oncology, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Via del Pozzo 71, 41122 Modena, Italy.
authors: G
authors: G
authors: Guaitoli
authors: Division of Medical Oncology, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Via del Pozzo 71, 41122 Modena, Italy.
authors: S
authors: S
authors: Noventa
authors: Breast Oncology Unit, Department of General Surgery and Surgical Specialities, University Hospital of Modena, Via del Pozzo 71, 41122 Modena, Italy.
authors: A
authors: A
authors: Andreotti
authors: Breast Oncology Unit, Department of General Surgery and Surgical Specialities, University Hospital of Modena, Via del Pozzo 71, 41122 Modena, Italy.
authors: A
authors: A
authors: Gambini
authors: Breast Oncology Unit, Department of General Surgery and Surgical Specialities, University Hospital of Modena, Via del Pozzo 71, 41122 Modena, Italy.
authors: E
authors: E
authors: Palma
authors: Breast Oncology Unit, Department of General Surgery and Surgical Specialities, University Hospital of Modena, Via del Pozzo 71, 41122 Modena, Italy.
authors: S
authors: S
authors: Papi
authors: Breast Oncology Unit, Department of General Surgery and Surgical Specialities, University Hospital of Modena, Via del Pozzo 71, 41122 Modena, Italy.
authors: G
authors: G
authors: Tazzioli
authors: Department of Medicine and Public Health, University Hospital of Modena, Via del Pozzo 71, 41122 Modena, Italy.
authors: S
authors: S
authors: Balduzzi
authors: Division of Medical Oncology, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Via del Pozzo 71, 41122 Modena, Italy.
authors: M
authors: M
authors: Dominici
authors: Division of Medical Oncology, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Via del Pozzo 71, 41122 Modena, Italy.
authors: S
authors: S
authors: Cascinu
authors: Division of Medical Oncology, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Via del Pozzo 71, 41122 Modena, Italy.
authors: F
authors: F
authors: Piacentini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018943:Anthracyclines / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001365:Axilla; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008408:Mastectomy / Q000379:methods; D015412:Mastectomy, Segmental / Q000379:methods*; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D015996:Survival Rate; D043823:Taxoids / Q000008:administration & dosage; D013997:Time Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data*
chemical_list: D018943:Anthracyclines; D043823:Taxoids
keywords: Breast cancer; Neoadjuvant chemotherapy; Time to surgery; pCR