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Oncologic Outcomes of Nipple-sparing Mastectomy and Immediate Reconstruction After Neoadjuvant Chemotherapy for Breast Cancer

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Abstract
Abstract
Objectives: To evaluate the oncologic outcomes and risk factors for locoregional recurrence (LRR) and nipple-areola complex recurrence (NR) in a large series of breast cancer patients who underwent nipple-sparing mastectomy (NSM) and immediate reconstruction after neoadjuvant chemotherapy (NACT).

Summary of background data: The use of NSM and immediate reconstruction in breast cancer patients receiving NACT is increasing. However, the oncologic safety of this approach is unclear.

Patients and methods: A total of 310 breast cancer patients (319 breasts) who underwent NACT and NSM between February 2010 and November 2016 were retrospectively analyzed. Clinical and pathologic factors associated with increased risks of LRR and NR were analyzed using univariate (Chi-square or Fisher exact test) and multivariate (Cox proportional hazard regression model) analyses.

Results: During a mean follow-up of 63 ± 22 months, 38 cases had LRR as the first event, including 6 cases of NR as the first event. The 5-year cumulative LRR and NR rates were 11.0% and 1.9%, respectively. In univariate analysis, clinical T stage, pathologic nodal status, histologic grade, lymphovascular invasion, and post-NACT Ki67 status were associated with increased LRR risk, and post-NACT Ki67 status was the only significant risk factor for NR. In multivariate analysis, post-NACT Ki67 ≥10% (hazard ratio, 4.245; 95% confidence interval, 1.865-9.663; P = 0.001) was an independent risk factor for LRR.

Conclusions: NSM and immediate reconstruction seem to be oncologically safe with acceptable LRR and NR rates for appropriately selected breast cancer patients treated with NACT. Post-NACT Ki67 ≥10% was associated with increased risk of LRR or NR, and therefore, necessitates cautious follow-up.
Author(s)
고범석공경엽김성배김지선김학희김희정손병호안세현엄진섭이새별이종원정일용Zhen Yu Wu
Issued Date
2021
Type
Article
Keyword
Adjuvant treatmentAdultAnalysisBreast cancerBreast Neopla는 - drug therapyBreast Neopla는 - surgeryCcancerChemotherapyAdjuvantFemaleHumansMammaplasyMammaplasty - methodsMastectomy - methodsMedical collegesMiddle AgedNeoadjuvant TherapyNeoplasm RecurrenceLocalNipplesOrgan Sapring TreatmentsRisk FactorsSurvival Rate
DOI
10.1097/SLA.0000000000003798
URI
https://oak.ulsan.ac.kr/handle/2021.oak/7577
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_proquest_miscellaneous_2383514985&context=PC&vid=ULSAN&lang=ko_KR&search_scope=default_scope&adaptor=primo_central_multiple_fe&tab=default_tab&query=any,contains,Oncologic%20Outcomes%20of%20Nipple-sparing%20Mastectomy%20and%20Immediate%20Reconstruction%20After%20Neoadjuvant%20Chemotherapy%20for%20Breast%20Cancer&offset=0&pcAvailability=true
Publisher
ANNALS OF SURGERY
Location
미국
Language
영어
ISSN
0003-4932
Citation Volume
247
Citation Number
6
Citation Start Page
e1196
Citation End Page
e1201
Appears in Collections:
Medicine > Medicine
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