Hospital Geral de Fortaleza, Fortaleza, CE, Brazil.
Grupo de Educação e Estudos Oncológicos, Fortaleza, CE, Brazil.
Rev Bras Ginecol Obstet. 2022 Nov;44(11):1052-1058. doi: 10.1055/s-0042-1751286. Epub 2022 Dec 29.
Nipple-sparing mastectomy (NSM) has been traditionally used in selected cases with tumor-to-nipple distance > 2 cm and negative frozen section of the base of the nipple. Recommending NSM in unselected populations remains controversial. The present study evaluated the oncological outcomes of patients submitted to NSM in an unselected population seen at a single center.
This retrospective cohort study included unselected patients with invasive carcinoma or ductal carcinoma in situ (DCIS) who underwent NSM in 2010 to 2020. The endpoints were locoregional recurrence, disease-free survival (DFS), and overall survival (OS), irrespective of tumor size or tumor-to-nipple distance.
Seventy-six patients (mean age 46.1 years) (58 invasive carcinomas/18 DCIS) were included. The most invasive carcinomas were hormone-positive (60%) (HER2 overexpression: 24%; triple-negative: 16%), while 39% of DCIS were high-grade. Invasive carcinomas were T2 in 66% of cases, with axillary metastases in 38%. Surgical margins were all negative. All patients with invasive carcinoma received systemic treatment and 38% underwent radiotherapy. After a mean of 34.8 months, 3 patients with invasive carcinoma (5.1%) and 1 with DCIS (5.5%) had local recurrence. Two patients had distant metastasis and died during follow-up. The 5-year OS and DFS rates for invasive carcinoma were 98% and 83%, respectively.
In unselected cases, the 5-year oncological outcomes following NSM were found to be acceptable and comparable to previous reports. Further studies are required.
乳头保留乳房切除术（NSM）传统上用于选择肿瘤距乳头>2cm 且乳头基底冷冻切片阴性的病例。在未选择的人群中推荐 NSM 仍存在争议。本研究评估了在单中心接受 NSM 的未选择人群的肿瘤学结果。
本回顾性队列研究纳入了 2010 年至 2020 年接受 NSM 的浸润性癌或导管原位癌（DCIS）的未选择患者。终点为局部区域复发、无病生存（DFS）和总生存（OS），无论肿瘤大小或肿瘤距乳头距离如何。
76 例患者（平均年龄 46.1 岁）（58 例浸润性癌/18 例 DCIS）被纳入。最常见的浸润性癌为激素阳性（60%）（HER2 过表达：24%；三阴性：16%），而 39%的 DCIS 为高级别。66%的浸润性癌为 T2，38%有腋窝转移。手术切缘均为阴性。所有浸润性癌患者均接受全身治疗，38%接受放疗。平均随访 34.8 个月后，3 例浸润性癌（5.1%）和 1 例 DCIS（5.5%）发生局部复发。2 例患者发生远处转移并在随访期间死亡。浸润性癌的 5 年 OS 和 DFS 率分别为 98%和 83%。
在未选择的病例中，NSM 后的 5 年肿瘤学结果是可以接受的，与以往报道相当。需要进一步研究。
