Wengler Craig A, Valente Stephanie A, Al-Hilli Zahraa, Woody Neil M, Muntean Julia H, Abraham Jame, Tendulkar Rahul D, Djohan Risal, O'Rourke Colin, Crowe Joseph P, Grobmyer Stephen R
Division of Breast Services, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio.
Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio.
J Surg Oncol. 2017 Dec;116(7):797-802. doi: 10.1002/jso.24741. Epub 2017 Jul 11.
We evaluated oncologic outcomes and complications of skin-sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) with immediate reconstruction (IR) after neoadjuvant chemotherapy (NAC) in patients with early-stage and locally advanced breast cancer (BC).
BC patients from 2000 to 2014 treated with NAC followed by SSM/NSM and IR were reviewed. Patient demographics, tumor characteristics, NAC response, complications, and recurrence were analyzed.
Two hundred sixty-nine patients with 280 BCs were treated with NAC followed by SSM (94%) or NSM (6%) with IR. Median age was 47 (26-72) years with a median follow-up of 45 months. Pathologic complete response (pCR) was noted in 49 (17.5%) cases. Overall 30-day complication rate was 13.2%. Variables associated with complications included BMI (P < 0.0001), tobacco use (P = 0.015), and adjuvant radiation (P = 0.025). Local-regional recurrence was 3.2% and metastatic recurrence was 13.2%. Variables predicting recurrence risk were pre-NAC tumor size (P < 0.001), residual tumor size (P = 0.002), Grade III (P = 0.002), HER-2 negative (P = 0.025), pre-NAC nodal disease (P = 0.05), and lack of pCR (P = 0.045).
Following NAC, risk factors for complications in patients undergoing SSM/NSM with IR are high BMI, smoking, and adjuvant XRT. SSM/NSM following NAC is associated with excellent local control. These data support expanding the indications for NSM/SSM to include patients receiving NAC.
我们评估了早期和局部晚期乳腺癌（BC）患者在新辅助化疗（NAC）后行保皮乳房切除术（SSM）和保乳乳头切除术（NSM）并即刻重建（IR）的肿瘤学结局及并发症情况。
回顾了2000年至2014年接受NAC治疗后行SSM/NSM和IR的BC患者。分析了患者人口统计学特征、肿瘤特征、NAC反应、并发症及复发情况。
269例患有280例BC的患者接受了NAC治疗，随后行SSM（94%）或NSM（6%）并IR。中位年龄为47（26 - 72）岁，中位随访时间为45个月。49例（17.5%）病例出现病理完全缓解（pCR）。总体30天并发症发生率为13.2%。与并发症相关的变量包括体重指数（BMI）（P < 0.0001）、吸烟（P = 0.015）和辅助放疗（P = 0.025）。局部区域复发率为3.2%，远处转移复发率为13.2%。预测复发风险的变量包括NAC前肿瘤大小（P < 0.001）、残留肿瘤大小（P = 0.002）、Ⅲ级（P = 0.002）、HER-2阴性（P = 0.025）、NAC前淋巴结疾病（P = 0.05）以及未达到pCR（P = 0.045）。
NAC后，行SSM/NSM并IR的患者发生并发症的危险因素为高BMI、吸烟和辅助放疗。NAC后行SSM/NSM与良好的局部控制相关。这些数据支持扩大NSM/SSM的适应证，将接受NAC的患者纳入其中。
