Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Breast Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
Ann Surg. 2021 Dec 1;274(6):e1196-e1201. doi: 10.1097/SLA.0000000000003798.
To evaluate the oncologic outcomes and risk factors for locoregional recurrence (LRR) and nipple-areola complex recurrence (NR) in a large series of breast cancer patients who underwent nipple-sparing mastectomy (NSM) and immediate reconstruction after neoadjuvant chemotherapy (NACT).
The use of NSM and immediate reconstruction in breast cancer patients receiving NACT is increasing. However, the oncologic safety of this approach is unclear.
A total of 310 breast cancer patients (319 breasts) who underwent NACT and NSM between February 2010 and November 2016 were retrospectively analyzed. Clinical and pathologic factors associated with increased risks of LRR and NR were analyzed using univariate (Chi-square or Fisher exact test) and multivariate (Cox proportional hazard regression model) analyses.
During a mean follow-up of 63 ± 22 months, 38 cases had LRR as the first event, including 6 cases of NR as the first event. The 5-year cumulative LRR and NR rates were 11.0% and 1.9%, respectively. In univariate analysis, clinical T stage, pathologic nodal status, histologic grade, lymphovascular invasion, and post-NACT Ki67 status were associated with increased LRR risk, and post-NACT Ki67 status was the only significant risk factor for NR. In multivariate analysis, post-NACT Ki67 ≥10% (hazard ratio, 4.245; 95% confidence interval, 1.865-9.663; P = 0.001) was an independent risk factor for LRR.
NSM and immediate reconstruction seem to be oncologically safe with acceptable LRR and NR rates for appropriately selected breast cancer patients treated with NACT. Post-NACT Ki67 ≥10% was associated with increased risk of LRR or NR, and therefore, necessitates cautious follow-up.
评估新辅助化疗（NACT）后行保乳头乳房切除术（NSM）和即刻重建的大量乳腺癌患者的局部区域复发（LRR）和乳头乳晕复合体复发（NR）的肿瘤学结果和危险因素。
在接受 NACT 的乳腺癌患者中，使用 NSM 和即刻重建的情况正在增加。但是，这种方法的肿瘤学安全性尚不清楚。
回顾性分析了 2010 年 2 月至 2016 年 11 月期间接受 NACT 和 NSM 的 310 例乳腺癌患者（319 例乳房）。使用单变量（卡方或 Fisher 确切检验）和多变量（Cox 比例风险回归模型）分析与 LRR 和 NR 风险增加相关的临床和病理因素。
在平均 63±22 个月的随访期间，38 例出现 LRR 作为首发事件，其中 6 例出现 NR 作为首发事件。5 年累积 LRR 和 NR 发生率分别为 11.0%和 1.9%。在单变量分析中，临床 T 分期、病理淋巴结状态、组织学分级、脉管侵犯和 NACT 后 Ki67 状态与 LRR 风险增加相关，而 NACT 后 Ki67 状态是 NR 的唯一显著危险因素。在多变量分析中，NACT 后 Ki67≥10%（风险比，4.245；95%置信区间，1.865-9.663；P=0.001）是 LRR 的独立危险因素。
对于接受 NACT 治疗的适当选择的乳腺癌患者，NSM 和即刻重建在肿瘤学上似乎是安全的，LRR 和 NR 发生率可接受。NACT 后 Ki67≥10%与 LRR 或 NR 风险增加相关，因此需要谨慎随访。
