Department of Breast Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
Breast Cancer Res Treat. 2022 Jan;191(2):345-354. doi: 10.1007/s10549-021-06428-9. Epub 2021 Oct 31.
Oncologic safety of postmastectomy breast reconstruction in young women with breast cancer is not well-defined, especially in the setting of neoadjuvant chemotherapy (NACT). We retrospectively compared the oncologic outcomes following nipple-sparing (NSM)/skin-sparing mastectomy (SSM) with immediate breast reconstruction (IBR) and conventional mastectomy (CM) alone in young breast cancer patients after NACT.
A total of 1266 women with primary breast cancer who underwent NACT followed by total mastectomy with or without IBR were reviewed. Of these, only young patients (age ≤ 40 years at diagnosis) were included in the outcome analysis (n = 375). After propensity score-matching by clinical T and N stage, molecular subtype, response to NACT, and adjuvant radiotherapy status, 228 patients were 1:1 matched, comprising balanced IBR group (with NSM/SSM) and CM-alone group.
The 5-year locoregional recurrence-free, disease-free, distant metastasis (DM)-free, and breast cancer-specific survival (BCSS) rates for the entire cohort of young patients were 83.4%, 65.3%, 71.7%, and 85.4%, respectively. Locoregional recurrence rates between the matched groups were similar (14% vs. 15.8%; p = 0.710); however, IBR group had significantly lower DM rate (27.2% vs. 40.4%; p = 0.036) and breast cancer mortality (14.9% vs. 27.2%; p = 0.023) than CM-alone group. IBR group showed significantly improved 5-year DM-free survival (74.1% vs. 62.6%; p = 0.043) and BCSS (89.1% vs. 77.6%; p = 0.048) rates than CM-alone group.
Our results indicated that IBR with NSM/SSM does not negatively affect long-term oncologic outcomes compared to CM alone in young women with breast cancer receiving NACT.
保乳术后乳房重建在年轻乳腺癌患者中的肿瘤安全性尚不确定，尤其是在新辅助化疗（NACT）的情况下。我们回顾性比较了 NACT 后接受保乳头（NSM）/皮肤保留乳房切除术（SSM）联合即刻乳房重建（IBR）和单纯常规乳房切除术（CM）的年轻乳腺癌患者的肿瘤学结果。
共对 1266 例接受 NACT 后行全乳切除术且接受或不接受 IBR 的原发性乳腺癌患者进行了回顾性分析。其中，仅纳入年轻患者（诊断时年龄≤40 岁）进行结局分析（n=375）。通过临床 T 和 N 分期、分子亚型、NACT 反应和辅助放疗状态进行倾向评分匹配后，228 例患者按 1:1 匹配，包括 IBR 组（NSM/SSM）和 CM 组。
年轻患者全队列的 5 年局部区域无复发生存率、无病生存率、远处无转移生存率和乳腺癌特异性生存率分别为 83.4%、65.3%、71.7%和 85.4%。匹配组间局部区域复发率相似（14%比 15.8%；p=0.710）；然而，IBR 组远处转移率明显较低（27.2%比 40.4%；p=0.036），乳腺癌死亡率较低（14.9%比 27.2%；p=0.023）。IBR 组 5 年远处无转移生存率（74.1%比 62.6%；p=0.043）和乳腺癌特异性生存率（89.1%比 77.6%；p=0.048）明显高于 CM 组。
我们的研究结果表明，在接受 NACT 的年轻乳腺癌患者中，与单纯 CM 相比，NSM/SSM 联合 IBR 不会对长期肿瘤学结果产生负面影响。
