Koppiker Chaitanyanand, Joshi Sneha, Mishra Rupa, Kelkar Devaki A, Chigurupati Pragnya, Joshi Anjali, John Jisha, Kadu Shweta, Bagdia Amitkumar, Thakkar Deepti, Deshmukh Chetan, Allampati Harikiran, Sharan Gautam, Dhar Upendra, Nare Smeeta, Nagarkar Sanket, Busheri Laleh, Varghese Beenu, Pai Mugdha
Orchids Breast Health Centre, Prashanti Cancer Care Mission, Pune, India.
Centre for Translational Cancer Research: A Joint Initiative of Indian Institute of Science Education and Research (IISER), Pune and Prashanti Cancer Care Mission (PCCM), Pune, India.
Front Oncol. 2023 Apr 14;13:1131951. doi: 10.3389/fonc.2023.1131951. eCollection 2023.
The majority of breast cancer patients from India usually present with advanced disease, limiting the scope of breast conservation surgery. Therapeutic mammoplasty (TM), an oncoplastic technique that permits larger excisions, is quite promising in such a scenario and well suited to breast cancer in medium-to-large-sized breasts with ptosis and in some cases of large or multifocal/multicentric tumors. Here, we describe our TM cohort of 205 (194 malignant and 11 benign) patients from 2012 to 2019 treated at a single surgeon center in India, the largest Asian dataset for TM.
All patients underwent treatment after careful discussions by a multidisciplinary tumor board and patient counseling. We report the clinicopathological profiles and surgical, oncological, cosmetic, and patient-related outcomes with different TM procedures.
The median age of breast cancer patients was 49 years; that of benign disease patients was 41 years. The breast cancer cohort underwent simple (n = 84), complex (n = 71), or extreme (n = 44) TM surgeries. All resection margins were analyzed through intra-operative frozen-section assessment with stringent rad-path analysis protocols. The margin positivity rate was found to be 1.4%. A majority of the cohort was observed to have pT1-pT2 tumors, and the median resection volume was 180 cc. Low post-operative complication rates and good-to-excellent cosmetic scores were observed. The median follow-up was 39 months. We observed 2.07% local and 5.7% distal recurrences, and disease-specific mortality was 3.1%. At median follow-up, the overall survival was observed to be 95.9%, and disease-free survival was found to be 92.2%. The patient-reported outcome measures (PROMs) showed good-to-excellent scores for all types of TMs across BREAST-Q domains.
We conclude that in India, a country where women present with large and locally advanced tumors, TM safely expands the indications for breast conservation surgery. Our results show oncological and cosmetic outcomes at acceptable levels. Most importantly, PROM scores suggest improved overall wellbeing and better satisfaction with the quality of life. For patients with macromastia, this technique not only focuses on cancer but also improves self-image and reduces associated physical discomfort often overlooked by women in the Indian setting. The popularization of this procedure will enable Indian patients with breast cancer to receive the benefits of breast conservation.
大多数来自印度的乳腺癌患者就诊时疾病已处于晚期，这限制了保乳手术的应用范围。治疗性乳房成形术（TM）是一种肿瘤整形技术，可允许更大范围的切除，在这种情况下颇具前景，非常适合治疗伴有乳房下垂的中至大型乳房的乳腺癌，以及某些大型或多灶性/多中心性肿瘤。在此，我们描述了2012年至2019年在印度一家由单一外科医生主刀的中心接受治疗的205例（194例恶性和11例良性）患者的TM队列，这是亚洲最大的TM数据集。
所有患者均在多学科肿瘤委员会仔细讨论并进行患者咨询后接受治疗。我们报告了不同TM手术的临床病理特征以及手术、肿瘤学、美容和患者相关结局。
乳腺癌患者的中位年龄为49岁；良性疾病患者为41岁。乳腺癌队列接受了单纯（n = 84）、复杂（n = 71）或极致（n = 44）TM手术。所有切除边缘均通过术中冰冻切片评估，并采用严格的放疗 - 病理分析方案进行分析。切缘阳性率为1.4%。队列中的大多数患者被观察为pT1 - pT2肿瘤，中位切除体积为180 cc。观察到术后并发症发生率低，美容评分良好至优秀。中位随访时间为39个月。我们观察到局部复发率为2.07%，远处复发率为5.7%，疾病特异性死亡率为3.1%。在中位随访时，总生存率为95.9%，无病生存率为92.2%。患者报告结局量表（PROMs）显示，在BREAST - Q各领域中，所有类型的TM评分均良好至优秀。
我们得出结论，在印度这个女性常表现为大型和局部晚期肿瘤的国家，TM安全地扩大了保乳手术的适应证。我们的结果显示肿瘤学和美容结局处于可接受水平。最重要的是，PROM评分表明整体幸福感得到改善，对生活质量的满意度更高。对于巨乳症患者，该技术不仅关注癌症，还改善了自我形象，并减轻了印度女性常被忽视的相关身体不适。该手术的推广将使印度乳腺癌患者受益于保乳治疗。
