Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
Ann Surg Oncol. 2023 Dec;30(13):8428-8435. doi: 10.1245/s10434-023-14278-6. Epub 2023 Sep 12.
Nipple-sparing mastectomy (NSM) outcomes in the elderly have not been well characterized. The goal of this study was to evaluate NSM outcomes in patients over age 60.
A single-institution retrospective cohort study was performed for NSM patients over the age of 60 from January 2004 to January 2022. Demographic, intraoperative, and postoperative variables were collected.
We identified 136 women who underwent a total of 200 NSMs at a mean age 65.2 years and with mean body mass index of 25. Most (56%) had invasive breast cancer, requiring neoadjuvant chemotherapy in 15%, and 17.5% had radiation prior to NSM. A total of 91% had immediate tissue expander placement. The infection rate was 19%, with 11.5% requiring expander explantation in the follow-up period. In binomial logistic regression analysis, prior radiation increased the odds of any complication by 2.9 (OR 2.93, CI 1.30-6.58, p = 0.009) and increased the odds of infection by 5.7 (OR 5.70, CI 1.95-16.66, p = 0.001), but no associations were seen for other covariates including age, comorbidities, prior chemotherapy, or presence of invasive disease. Diabetes increased the odds of wound breakdown specifically by 9.0 (OR 8.97, CI 2.01-39.92, p = 0.004). Local recurrence was 3% in mean 3.4-year follow-up.
Our data support NSM in patients over the age of 60 years with acceptable outcomes within the standard of care. Locoregional recurrence was within the cited range of 0-5%, and only diabetes and prior radiation were associated with reconstructive complications. NSM should thus be offered when appropriate regardless of increased age to achieve oncologic and reconstructive goals.
乳头保留乳房切除术（NSM）在老年患者中的效果尚未得到充分描述。本研究的目的是评估 60 岁以上患者的 NSM 结果。
对 2004 年 1 月至 2022 年 1 月期间在 60 岁以上接受 NSM 的患者进行了单机构回顾性队列研究。收集了人口统计学、术中及术后变量。
我们共确定了 136 名女性，共进行了 200 次 NSM，平均年龄为 65.2 岁，平均 BMI 为 25。大多数（56%）患有浸润性乳腺癌，其中 15%需要新辅助化疗，17.5%在 NSM 前接受放疗。共有 91%的患者立即放置了组织扩张器。感染率为 19%，其中 11.5%在随访期间需要取出扩张器。在二项逻辑回归分析中，放疗使任何并发症的发生几率增加了 2.9 倍（OR 2.93，95%CI 1.30-6.58，p = 0.009），使感染的发生几率增加了 5.7 倍（OR 5.70，95%CI 1.95-16.66，p = 0.001），但未观察到年龄、合并症、化疗史或浸润性疾病等其他协变量的相关性。糖尿病使伤口破裂的发生几率具体增加了 9.0 倍（OR 8.97，95%CI 2.01-39.92，p = 0.004）。在平均 3.4 年的随访中，局部复发率为 3%。
我们的数据支持 60 岁以上患者行 NSM，且在标准治疗范围内获得可接受的结果。局部复发率在报道的 0-5%范围内，只有糖尿病和放疗史与重建并发症相关。因此，应根据患者情况酌情选择 NSM，以实现肿瘤学和重建目标，而不考虑年龄增加。
