Breast Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy.
Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, , Milan, Italy.
Updates Surg. 2022 Apr;74(2):479-489. doi: 10.1007/s13304-021-01122-3. Epub 2021 Jun 28.
Salvage mastectomy is regarded as the treatment of first choice for ipsilateral breast cancer recurrence (IBCR), even if a second breast conserving surgery (BCS) is feasible. The purpose of this study was to compare the long-term oncological outcomes of IBCR patients who had undergone either mastectomy or second BCS, performing a propensity score matching (PSM) analysis to reduce the selection bias. All the consecutive patients with IBCR were retrospectively reviewed and divided into two different groups of treatment: repeat BCS versus salvage mastectomy. The propensity score predicting the probability of surgical treatment was determined for each patient and a 1:1 matching was performed. Disease-free survival (DFS), distant disease-free survival (DDFS), overall survival (OS), and breast cancer-specific survival (BCSS) were analyzed and compared between the two groups. A total of 309 patients underwent surgical treatment for IBCR. After PSM, 108 patients treated with repeat BCS and 108 patients treated with salvage mastectomy were included in the analysis. There was no significant difference in terms of DFS between patients with IBCR receiving repeat BCS or salvage mastectomy (p = 0.167). However, patients with IBCR undergoing second BCS had significantly better DDFS, OS, and BCSS compared to salvage mastectomy (p < 0.001). Salvage mastectomy should not be considered the optimal treatment for IBCR and it does not seem to improve prognosis compared to repeat conserving surgery. Second BCS for IBCR is a safe option with encouraging long-term oncological outcomes and should be proposed to all patients, when technically feasible.
挽救性乳房切除术被认为是同侧乳腺癌复发（IBCR）的首选治疗方法，即使可行二次保乳手术（BCS）也是如此。本研究的目的是比较接受乳房切除术或二次 BCS 的 IBCR 患者的长期肿瘤学结果，并进行倾向评分匹配（PSM）分析以减少选择偏倚。回顾性分析所有连续的 IBCR 患者，并将其分为两种不同的治疗组：重复 BCS 与挽救性乳房切除术。为每位患者确定预测手术治疗概率的倾向评分，并进行 1:1 匹配。分析并比较两组之间无病生存率（DFS）、远处无病生存率（DDFS）、总生存率（OS）和乳腺癌特异性生存率（BCSS）。共有 309 例患者接受了 IBCR 的手术治疗。PSM 后，将 108 例接受重复 BCS 治疗的患者和 108 例接受挽救性乳房切除术的患者纳入分析。接受重复 BCS 或挽救性乳房切除术治疗的 IBCR 患者在 DFS 方面无显著差异（p=0.167）。然而，接受二次 BCS 的 IBCR 患者在 DDFS、OS 和 BCSS 方面明显优于挽救性乳房切除术（p<0.001）。挽救性乳房切除术不应被视为 IBCR 的最佳治疗方法，与重复保乳手术相比，它似乎并不能改善预后。对于 IBCR，二次 BCS 是一种安全的选择，具有令人鼓舞的长期肿瘤学结果，在技术可行的情况下，应向所有患者推荐。
