title: Fewer Reoperations After Lumpectomy for Breast Cancer with Neoadjuvant Rather than Adjuvant Chemotherapy: A Report from the National Cancer Database.
abstract: BACKGROUND
  Reoperations occur frequently after initial lumpectomy for breast cancer. The authors hypothesized that the receipt of neoadjuvant chemotherapy (NAC) is associated with fewer reoperations.
  
  
  METHODS
  The association between timing of chemotherapy and reoperation rates (ROR) after lumpectomy was investigated for patients with stages 1-3 breast cancer in the National Cancer Database (NCDB) from 2010 to 2013 by multivariable logistic regression modeling. Then propensity score-matching was performed.
  
  
  RESULTS
  The unadjusted ROR for 71,627 stages 1-3 patients was 11.4% for those who had NAC compared with 20.3% for those who had postoperative chemotherapy (p < 0.001) (odds ratio [OR] 0.53; 95% confidence interval [CI] 0.49-0.57; p < 0.001). The ORs for the reoperations performed for patients with stages 1, 2, and 3 cancers who received NAC were respectively 0.65 (95% CI 0.56-0.75), 0.50 (95% CI 0.45-0.56), and 0.27 (95% CI 0.19-0.38) The p values for all were lower than 0.001.
  
  
  CONCLUSIONS
  For a population of patients receiving chemotherapy, the receipt of chemotherapy before instead of after surgery was associated with fewer reoperations after initial lumpectomy for breast cancer.
authors.affiliation: Department of Medical Research, Gundersen Medical Foundation, La Crosse, WI, USA. jlanderc@gundersenhealth.org.|Norma J. Vinger Center for Breast Care, Gundersen Health System, La Crosse, WI, USA. jlanderc@gundersenhealth.org.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Landercasper
authors.affiliation: Department of Mathematics and Statistics, University of Wisconsin La Crosse, La Crosse, WI, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Bennie
authors.affiliation: Department of Medical Oncology, Gundersen Health System, La Crosse, WI, USA.
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Parsons
authors.affiliation: Department of Medical Oncology, Gundersen Health System, La Crosse, WI, USA.
authors.forename: Leah L
authors.initials: LL
authors.lastname: Dietrich
authors.affiliation: Department of Surgery, University of Wisconsin Madison, 600 Highland Avenue, Madison, WI, USA.
authors.forename: Caprice C
authors.initials: CC
authors.lastname: Greenberg
authors.affiliation: Department of Surgery, University of Wisconsin Madison, 600 Highland Avenue, Madison, WI, USA.
authors.forename: Lee G
authors.initials: LG
authors.lastname: Wilke
authors.affiliation: Norma J. Vinger Center for Breast Care, Gundersen Health System, La Crosse, WI, USA.|Department of Surgery, Gundersen Health System, La Crosse, WI, USA.
authors.forename: Jared H
authors.initials: JH
authors.lastname: Linebarger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data*; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000706:statistics & numerical data*; D011379:Prognosis; D012086:Reoperation / Q000706:statistics & numerical data*; D024162:Second-Look Surgery / Q000706:statistics & numerical data*; D015996:Survival Rate; D055815:Young Adult