L'Institut du Sein - Paris Breast Centre, Paris, France.
Department of Conservation, Hamilton, New Zealand.
Ann Surg Oncol. 2021 Oct;28(11):5920-5928. doi: 10.1245/s10434-021-09829-8. Epub 2021 Mar 28.
Oncoplastic surgery (OPS) has extended the indications for breast-conserving surgery (BCS). Its role in patients with large breast cancers treated with neoadjuvant chemotherapy (NAC) is unclear. This study evaluated the oncological safety of OPS for tumors with partial response after NAC.
A consecutive series of 65 patients who underwent OPS (study group) after NAC for large breast cancer from January 2004 to July 2018 was compared with 130 matched patients treated by NAC, followed by standard BCS in 65 cases and mastectomy in 65 cases (two case-controlled groups).
The mean initial radiological tumor size was 46 mm. Residual pathological tumor size was 22 mm in the OPS cohort, 19 mm in the standard BCS cohort, and 31 mm in the mastectomy cohort (p > 0.05). The mean follow-up was 59 months in the study cohort. Five-year local recurrence rates were 0%, 0%, and 10.5% (0-22%) for the OPS, BCS, and mastectomy cohorts, respectively, while 5-year regional recurrence rates were 4.1% (0-11.1%), 0, and 19.4% (0-35.2%, p > 0.05), respectively. Five-year overall survival was 85.3% for the OPS cohort, 94.1% for the standard BCS cohort (p = 0.194), and 79.9% for the mastectomy cohort (p = 0.165).
OPS is safe after NAC for large breast cancers, and provides excellent local control, identical to that of tumors with a better response, treated by standard BCS. After NAC, OPS can be a valuable treatment option for tumors that did not shrink optimally and would not be suitable for standard BCS.
肿瘤整形术（OPS）扩大了保乳手术（BCS）的适应证。它在接受新辅助化疗（NAC）治疗的大乳腺癌患者中的作用尚不清楚。本研究评估了 OPS 对 NAC 后部分缓解肿瘤的肿瘤学安全性。
连续 65 例接受 NAC 治疗的大乳腺癌患者（研究组）于 2004 年 1 月至 2018 年 7 月期间接受 OPS，与 65 例接受 NAC 后标准 BCS 和 65 例接受 NAC 后乳房切除术的患者进行比较（两组对照）。
初始放射学肿瘤大小的平均值为 46mm。OPS 组残留病理肿瘤大小为 22mm，标准 BCS 组为 19mm，乳房切除术组为 31mm（p>0.05）。研究组平均随访时间为 59 个月。OPS、BCS 和乳房切除术组的 5 年局部复发率分别为 0%、0%和 10.5%（0-22%），5 年区域复发率分别为 4.1%（0-11.1%）、0%和 19.4%（0-35.2%），p>0.05）。OPS 组的 5 年总生存率为 85.3%，标准 BCS 组为 94.1%（p=0.194），乳房切除术组为 79.9%（p=0.165）。
NAC 治疗大乳腺癌后行 OPS 是安全的，与标准 BCS 治疗反应较好的肿瘤相比，局部控制效果同样出色。NAC 后，OPS 可以成为肿瘤非最佳缩小且不适合标准 BCS 的一种有价值的治疗选择。
