Ryu Jai Min, Park Sungmin, Paik Hyun-June, Nam Seok Jin, Kim Seok Won, Lee Se Kyung, Yu Jonghan, Bae Soo Youn, Kim Isaac, Bang Sa Ik, Mun Goo-Hyun, Pyon Jai-Kyong, Jeon Byung-Joon, Lee Jeong Eon
Division of Breast and Endocrine surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Clin Breast Cancer. 2017 Jun;17(3):204-210. doi: 10.1016/j.clbc.2016.10.009. Epub 2016 Oct 27.
Although the indication for immediate breast reconstruction (IBR) after skin-sparing mastectomy (SSM) or nipple-sparing mastectomy (NSM) has been expanded, IBR after neoadjuvant chemotherapy (NACT) is still controversial. We conducted retrospective matched case-control study to analyze oncologic outcomes between patients who underwent TM only and those who underwent IBR after SSM or NSM after NACT.
A retrospective review of breast cancer patients who underwent IBR after SSM or NSM after NACT between 2008 and 2015 at a single center was conducted. These cases were maximally matched by 1:5 to patients who underwent total mastectomy (TM) alone after NACT. Matching variables included age, clinical T and N stage before NACT, response to NACT, and pathologic stage after NACT. Pathologic stage followed the 7th edition of the American Joint Committee on Cancer (AJCC) classification.
Overall, 31 patients were enrolled onto the IBR after SSM or NSM group (study group) and matched to 85 patients (control group). In the study group, 13 patients (41.9%) underwent NSM and 18 (58.1%) underwent SSM. Median follow-up duration was 29.2 (range, 7-31) and 38.8 (range, 11-85) months for the study and control groups (P = .012), respectively, and median age was 37.0 (range, 26-57) and 40.0 (range, 24-56) years (P = .890), respectively. Overall survival (P = .971), disease-free survival (P = .520), distant metastasis-free survival (P = .795), and local recurrence-free survival (P = .628) did not differ significantly between the 2 groups.
IBR after SSM or NSM might be a feasible surgical treatment option even in breast cancer patients who underwent NACT.
尽管保乳皮肤乳房切除术（SSM）或保乳乳头乳房切除术（NSM）后即刻乳房重建（IBR）的适应证有所扩大，但新辅助化疗（NACT）后的IBR仍存在争议。我们进行了一项回顾性配对病例对照研究，以分析仅接受全乳切除术（TM）的患者与在NACT后接受SSM或NSM后IBR的患者之间的肿瘤学结局。
对2008年至2015年在单一中心接受NACT后行SSM或NSM后IBR的乳腺癌患者进行回顾性研究。这些病例与仅在NACT后接受全乳切除术（TM）的患者按最大1:5进行配对。配对变量包括年龄、NACT前的临床T和N分期、对NACT的反应以及NACT后的病理分期。病理分期遵循美国癌症联合委员会（AJCC）第7版分类。
总体而言，31例患者纳入SSM或NSM后IBR组（研究组），并与85例患者（对照组）配对。在研究组中，13例患者（41.9%）接受了NSM，18例（58.1%）接受了SSM。研究组和对照组的中位随访时间分别为29.2（范围7 - 31）个月和38.8（范围11 - 85）个月（P = .012），中位年龄分别为37.0（范围26 - 57）岁和40.0（范围24 - 56）岁（P = .890）。两组之间的总生存期（P = .971）、无病生存期（P = .520）、无远处转移生存期（P = .795）和无局部复发生存期（P = .628）差异均无统计学意义。
即使在接受NACT的乳腺癌患者中，SSM或NSM后的IBR可能也是一种可行的手术治疗选择。
