Research Article| Volume 43, ISSUE 4, P613-618, April 2017

Download started.


Impact of time to surgery after neoadjuvant chemotherapy in operable breast cancer patients

Published:October 20, 2016DOI:



      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.

      Patients and 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.


      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).


      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.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to European Journal of Surgical Oncology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Schott A.F.
        • Hayes D.F.
        Defining the benefits of neoadjuvant chemotherapy for breast cancer.
        J Clin Oncol. 2012; 30: 1747-1749
        • Thompson A.M.
        • Moulder-Thompson S.L.
        Neoadjuvant treatment of breast cancer.
        Ann Oncol. 2012; 23: x231-x236
        • Teshome M.
        • Hunt K.K.
        Neoadjuvant therapy in the treatment of breast cancer.
        Surg Oncol Clin N Am. 2014; 23: 505-523
        • Sanford R.A.
        • Lei X.
        • Barcenas C.H.
        • et al.
        Impact of time from completion of neoadjuvant chemotherapy to surgery on survival outcomes in breast cancer patients.
        Ann Surg Oncol. 2016; 23: 1515-1521
        • Fisher B.
        • Saffer E.
        • Rudock C.
        • Coyle J.
        • Gunduz N.
        Effect of local or systemic treatment prior to primary tumor removal on the production and response to a serum growth-stimulating factor in mice.
        Cancer Res. 1989; 49: 2002-2004
        • Jara Sánchez C.
        • Ruiz A.
        • Martín M.
        • et al.
        Influence of timing of initiation of adjuvant chemotherapy over survival in breast cancer: a negative outcome study by the Spanish Breast Cancer Research Group (GEICAM).
        Breast Cancer Res Treat. 2007; 101: 215-223
        • Lohrisch C.
        • Paltiel C.
        • Gelmon K.
        • et al.
        Impact on survival of time from definitive surgery to initiation of adjuvant chemotherapy for early-stage breast cancer.
        J Clin Oncol. 2006; 24: 4888-4894
        • Colleoni M.
        • Bonetti M.
        • Coates A.S.
        • et al.
        Early start of adjuvant chemotherapy may improve treatment outcome for premenopausal breast cancer patients with tumors not expressing estrogen receptors. The International Breast Cancer Study Group.
        J Clin Oncol. 2000; 18: 584-590
        • Buzdar A.U.
        • Smith T.L.
        • Powell K.C.
        • Blumenschein G.R.
        • Gehan E.A.
        Effect of timing of initiation of adjuvant chemotherapy on disease-free survival in breast cancer.
        Breast Cancer Res Treat. 1982; 2: 163-169
        • Shannon C.
        • Ashley S.
        • Smith I.E.
        Does timing of adjuvant chemotherapy for early breast cancer influence survival?.
        J Clin Oncol. 2003; 21: 3792-3797
        • Cold S.
        • Düring M.
        • Ewertz M.
        • Knoop A.
        • Møller S.
        Does timing of adjuvant chemotherapy influence the prognosis after early breast cancer? Results of the Danish Breast Cancer Cooperative Group (DBCG).
        Br J Cancer. 2005; 93: 627-632
        • Gagliato Dde M.
        • Gonzalez-Angulo A.M.
        • Lei X.
        • et al.
        Clinical impact of delaying initiation of adjuvant chemotherapy in patients with breast cancer.
        J Clin Oncol. 2014; 32: 735-744
        • Senkus E.
        • Kyriakides S.
        • Ohno S.
        • et al.
        Primary breast cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up.
        Ann Oncol. 2015; 26: v8-30
        • Wilson A.R.
        • Marotti L.
        • Bianchi S.
        • et al.
        The requirements of a specialist Breast Centre.
        Eur J Cancer. 2013; 49: 3579-3587
        • Norton L.
        Evolving concepts in the systemic drug therapy of breast cancer.
        Semin Oncol. 1997; 24 (S10–S13-S10-10)