Neoadjuvant Chemo Does Not Raise Postoperative Complication Risk

A large database study found that the use of neoadjuvant chemotherapy in breast cancer patients does not raise the risk of postoperative surgical complications. The study was presented at the 2015 American Society of Clinical Oncology (ASCO) Breast Cancer Symposium in San Francisco (abstract 115).

Erin Cordeiro, MD, of the University of Toronto, presented the study. She said that recent work has confirmed that the use of neoadjuvant chemotherapy has been increasing over the last decade or so. “As surgeons, most of us are a bit concerned about cytotoxic chemotherapy, and we feel that there may be an increase in postoperative complications when patients undergo surgery in the neoadjuvant chemotherapy setting.” Some surgeons, she said, wait 4 to 6 weeks to perform surgery as a result.

The new study analyzed data from the American College of Surgeon’s NSQIP database, which includes information from hundreds of hospitals in the United States, Canada, and Europe. The NSQIP database defines neoadjuvant chemotherapy as any administered within 30 days preoperatively. The study’s cohort included patients undergoing surgery for invasive breast cancer from 2005 to 2012, and excluded various high-risk patients.

The final cohort included 67,685 patients; 3,624 of those received neoadjuvant chemotherapy. Those patients were younger, and were more likely to undergo bilateral surgery. The percentage of the total who received neoadjuvant chemotherapy rose from 5.5% in 2005 to 10.2% in 2012. Patients who did receive neoadjuvant therapy were less likely to have medical comorbidities including diabetes, a history of chronic obstructive pulmonary disease, and hypertension.

On an unadjusted analysis, it did appear that neoadjuvant chemotherapy resulted in more complications; the overall 30-day morbidity rate was 4.9%, compared with 3.7% in those who did not receive chemotherapy (P = .0003). This was largely due to a higher rate of infectious and bleeding complications in the chemotherapy patients.

However, after a propensity-score adjusted analysis, the difference was no longer significant. The odds ratio for postoperative complications in neoadjuvant chemotherapy patients was 1.16 (95% confidence interval [CI], 0.98–1.36), which did not reach significance.

“Neoadjuvant chemotherapy did not turn out to be an independent predictor of postoperative complications,” Cordeiro said.

The discussant for the session, Charles E. Geyer, MD, FACP, of the Virginia Commonwealth University Massey Cancer Center, stressed that the NSQIP database is very carefully conducted, which offers support for these findings. “This is coming from a very strong, validated data set,” he said. “I really think this should put to rest the concern that surgeons might have about neoadjuvant chemotherapy.”