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Influence Of Neoadjuvant Chemotherapy Regimen On Breast Reconstruction Outcomes
Olamide Olawoyin, BSc, Sumarth Mehta, BSc, Fouad Chouairi, BSc, John Persing, MD, Lajos Pusztai, MD, DPhil, Michael Alperovich, MD, MSc.
Yale School of Medicine, NEW HAVEN, CT, USA.

PURPOSE: Neoadjuvant chemotherapy (NACT) provides a survival advantage in breast cancer. Evidence to date has evaluated the impact of chemotherapy on autologous breast reconstruction outcomes as a binary variable. In this study, comparisons of specific NACT regimens and schedules as well as the resulting circulating immune markers on autologous breast reconstruction complication rates were evaluated.
METHODS: Following IRB approval, patients who underwent NACT and microvascular breast reconstruction at Yale New-Haven Hospital between 2013 and 2018 were identified. Demographics, oncologic history, chemotherapy regimens, and complication profiles were recorded. Chemotherapy regimens were stratified by the presence or absence of anthracycline as well as the order of taxane administration in the anthracyline-containing regimen. Dosage, days between completion of chemotherapy and immediate reconstruction, and complete blood count (WBC, ANC, ALC, and ratio of ANC & ALC) at the time of the last chemotherapy administration were analyzed. Chi-squared tests, Fischer-exact tests, and t-tests were used for univariate analysis. Multivariate logistic regression was used to control for confounding variables and comparisons of groups with and without complications.
RESULTS: One hundred patients met the inclusion criteria. In a multivariate regression model controlling for significant covariates like BMI and ASA, the administration of taxane first in an anthracycline-containing chemotherapy regimen was associated with increased complications (OR 3.347, p 0.020, see image below). Particularly, the administration of taxane first in neoadjuvant chemotherapy was associated with a 2.9 fold increase in the risk of fat necrosis (OR 2.905, p 0.029). There was no correlation between anthracycline inclusion and postoperative outcomes. The dosage of chemotherapy, the number of days between NACT completion and surgery, and the number of circulating immune cells had no significant effect on postoperative outcomes.
CONCLUSION: The administration of taxane first in an anthracycline-containing NACT regimen contributes to an increase in minor post-operative autologous breast reconstruction complications. Our report has the potential to inform the sequence of NACT administration, thus reducing post-operative complication outcomes.


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