Li Shouyu, Zhao Yuting, Yan Lutong, Yang Zejian, Qiu Pei, Chen Heyan, Zhou Yudong, Niu Ligang, Yan Yu, Zhang Wei, Zhang Huimin, He Jianjun, Zhou Can
Department of Breast Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Xi'an Jiaotong University Health Science Center, Xi'an, China.
Front Oncol. 2022 Apr 14;12:848187. doi: 10.3389/fonc.2022.848187. eCollection 2022.
Due to the lack of randomized controlled trial, the effectiveness and oncological safety of nipple-excising breast-conserving therapy (NE-BCT) for female breast cancer (FBC) remains unclear. We aimed to explore and investigate the prognostic value of NE-BCT versus nipple-sparing breast-conserving therapy (NS-BCT) for patients with early FBC.
In this cohort study, data between NE-BCT and NS-BCT groups of 276,661 patients diagnosed with tumor-node-metastasis (TNM) stage 0-III FBC from 1998 to 2015 were retrieved from the Surveillance, Epidemiology, and End Results database. Propensity score matching analysis, Kaplan-Meier, X-tile, Cox proportional hazards model, and competing risk model were performed to evaluate the effectiveness and oncological safety for patients in NE-BCT and NS-BCT groups.
A total of 1,731 (0.63%) patients received NE-BCT (NE-BCT group) and 274,930 (99.37%) patients received NS-BCT (NS-BCT group); 44,070 subjects died after a median follow-up time of 77 months (ranging from 1 to 227 months). In the propensity score matching (PSM) cohort, NE-BCT was found to be an adversely independent prognostic factor affecting overall survival (OS) [hazard ratio (HR), 1.24; 95% CI, 1.06-1.45, =0.0078]. Subjects in NE-BCT group had similar breast-cancer-specific survival (BCSS) (HR, 1.15; 95%CI, 0.88-1.52, =0.30) and worse other-causes-specific death (OCSD) (HR, 1.217; 95%CI, 1.002-1.478, =0.048<0.05) in comparison with those in the NS-BCT group.
Our study demonstrated that the administration of NE-BCT is oncologically safe and reliable and can be widely recommended in clinics for women with non-metastatic breast cancer.
由于缺乏随机对照试验，乳头切除保乳治疗（NE-BCT）对女性乳腺癌（FBC）的有效性和肿瘤学安全性仍不明确。我们旨在探讨和研究NE-BCT与保留乳头保乳治疗（NS-BCT）对早期FBC患者的预后价值。
在这项队列研究中，从监测、流行病学和最终结果数据库中检索了1998年至2015年诊断为肿瘤-淋巴结-转移（TNM）0-III期FBC的276,661例患者的NE-BCT组和NS-BCT组的数据。进行倾向评分匹配分析、Kaplan-Meier分析、X-tile分析、Cox比例风险模型和竞争风险模型，以评估NE-BCT组和NS-BCT组患者的有效性和肿瘤学安全性。
共有1731例（0.63%）患者接受了NE-BCT（NE-BCT组），274,930例（99.37%）患者接受了NS-BCT（NS-BCT组）；44,070例受试者在中位随访时间77个月（范围1至227个月）后死亡。在倾向评分匹配（PSM）队列中，发现NE-BCT是影响总生存期（OS）的不良独立预后因素[风险比（HR），1.24；95%置信区间（CI），1.06-1.45，P=0.0078]。与NS-BCT组相比，NE-BCT组受试者的乳腺癌特异性生存期（BCSS）相似（HR，1.15；95%CI，0.88-1.52，P=0.30），其他原因特异性死亡（OCSD）更差（HR，1.217；95%CI，1.002-1.478，P=0.048<0.05）。
我们的研究表明，NE-BCT的应用在肿瘤学上是安全可靠的，可在临床上广泛推荐给非转移性乳腺癌女性患者。
