Sisco Mark, Kyrillos Alexandra M, Lapin Brittany R, Wang Chihsiung E, Yao Katharine A
Division of Plastic Surgery, NorthShore University HealthSystem, Northbrook, IL, 60062, USA.
Division of Surgical Oncology, NorthShore University HealthSystem, Evanston, IL, 60201, USA.
Breast Cancer Res Treat. 2016 Nov;160(1):111-120. doi: 10.1007/s10549-016-3975-9. Epub 2016 Sep 12.
For many women, nipple-sparing mastectomy (NSM) provides aesthetic and quality-of-life outcomes superior to skin-sparing mastectomy. Accumulating data suggest that NSM provides similar oncologic outcomes in select breast cancer patients. This study sought to determine national trends in NSM use.
Using the National Cancer Data Base, 6254 women with breast cancer who underwent NSM between 2010 and 2013 were identified. NSM rates were determined relative to the number of patients who received a mastectomy with reconstruction (n = 114,849). Associations between patient, tumor, and facility characteristics and NSM were assessed using logistic regression.
The rate of NSM increased from 2.9 to 8.0 % between 2010 and 2013. NSM was most commonly performed in academic (adjusted odds ratio [OR] 1.43, p < 0.001) and high-volume (OR 1.59, p < 0.001) breast centers. There was up to a 5.8-fold variation in its delivery between geographic census regions (p < 0.001). Of 1231 hospitals, only 491 (39.9 %) reported performing at least one NSM during the study period. Half of all NSMs were performed by the top 6 % (n = 30) of NSM-performing centers. NSM was associated with small tumor size (p < 0.001), lower tumor grades (p < 0.05), and negative nodal status (p < 0.001). However, half of NSM patients had at least one tumor characteristic that diverged from current (2016) NCCN recommendations for the procedure.
The use of therapeutic NSM is increasing dramatically in the United States, despite recommendations that the procedure be used with caution. As NSM becomes increasingly common, efforts are needed to monitor its long-term oncologic outcomes and to ensure equitable access to it.
对于许多女性而言，保留乳头的乳房切除术（NSM）在美学效果和生活质量方面优于保留皮肤的乳房切除术。越来越多的数据表明，NSM在特定乳腺癌患者中能提供相似的肿瘤学结局。本研究旨在确定NSM使用情况的全国趋势。
利用国家癌症数据库，确定了2010年至2013年间接受NSM的6254例乳腺癌女性患者。NSM率相对于接受乳房切除术后重建的患者数量（n = 114,849）来确定。使用逻辑回归评估患者、肿瘤和机构特征与NSM之间的关联。
2010年至2013年间，NSM率从2.9%增至8.0%。NSM最常在学术性（校正比值比[OR] 1.43，p < 0.001）和大容量（OR 1.59，p < 0.001）乳腺中心进行。其实施在地理普查区域之间存在高达5.8倍的差异（p < 0.001）。在1231家医院中，只有491家（39.9%）报告在研究期间至少进行了1例NSM。所有NSM中有一半是由NSM实施中心中排名前6%（n = 30）的中心进行的。NSM与肿瘤体积小（p < 0.001）、肿瘤分级较低（p < 0.05）和淋巴结阴性状态（p < 0.001）相关。然而，一半的NSM患者至少有一项肿瘤特征与当前（2016年）NSM的NCCN推荐不符。
尽管有建议谨慎使用该手术，但在美国，治疗性NSM的使用正在急剧增加。随着NSM越来越普遍，需要努力监测其长期肿瘤学结局，并确保公平获得该手术。
