Factors Predicting Locoregional Recurrence After Neoadjuvant Chemotherapy and Nipple-Sparing/Skin-Sparing Mastectomy With Immediate Breast Reconstruction.

Zhen-Yu Wu,Byung-Ho Son,Jae Ho Jeong,Jin Sup Eom,Hak Hee Kim,Hee Jeong Kim,Sei-Hyun Ahn,Gyungyub Gong,Il Yong Chung,Jong Won Lee,Jisun Kim,Beomseok Ko,Sae Byul Lee

doi:10.3389/fonc.2021.675955

Abstract

BackgroundFew data are available on the risk factors of locoregional recurrence (LRR) after neoadjuvant chemotherapy (NACT) and immediate breast reconstruction (IBR) in breast cancer. Herein, we evaluated the factors predicting LRR in a large series of patients who underwent either nipple- (NSM) or skin-sparing mastectomy (SSM) with IBR after NACT.MethodsWe retrospectively analyzed 609 breast cancer patients who underwent NACT and NSM/SSM with IBR between February 2010 and June 2017. Factors associated with an increased risk of LRR were analyzed by univariate (chi-square or Fisher’s exact test) and multivariate (Cox proportional hazard regression model) analyses.ResultsDuring a median follow-up of 63 months, LRR as the first event occurred in 73 patients, and the 5-year cumulative LRR rate was 10.8%. Multivariate analysis revealed post-NACT Ki67 ≥ 10% [hazard ratio (HR), 2.208; 95% confidence interval (CI), 1.295-3.765; P = 0.004], high tumor grade (HR, 1.738; 95% CI, 1.038-2.908; P = 0.035), and presence of lymphovascular invasion (LVI) (HR, 1.725; 95% CI, 1.039-2.864; P = 0.035) as independently associated with increased LRR risk. The 10-year LRR rate was 8.5% for patients with none of the three associated risk factors, 11.6% with one factor, 25.1% with two factors, and 33.7% with all three factors (P < 0.001).ConclusionsPost-NACT Ki67 ≥ 10%, high tumor grade, and presence of LVI are independently associated with an increased risk of developing LRR after NACT and NSM/SSM with IBR. Future prospective trials are warranted to decrease the risk of LRR in patients with associated risk factors.

Highlights

Neoadjuvant chemotherapy (NACT) has been established as the standard of care for locally advanced breast cancer and is being used more often as a treatment in early-stage breast cancer [1]
locoregional recurrence (LRR) as the first event occurred in 73 patients, and the 5-year cumulative LRR rate was 10.8%
PostNACT Ki67 ≥ 10% [hazard ratio (HR), 2.208; 95% confidence interval (CI), 1.295-3.765; P = 0.004], high tumor grade (HR, 1.738; 95% CI, 1.038-2.908; P = 0.035), and presence of lymphovascular invasion (LVI) (HR, 1.725; 95% CI, 1.039-2.864; P = 0.035) were independently associated with reduced LRR-free survival in the multivariate analysis (Table 4)

Summary

Introduction

Neoadjuvant chemotherapy (NACT) has been established as the standard of care for locally advanced breast cancer and is being used more often as a treatment in early-stage breast cancer [1]. Patients have begun to prefer nipple- (NSM) or skin-sparing mastectomy (SSM) combined with immediate breast reconstruction (IBR) in the treatment of breast cancer, as it provides improved aesthetic results and quality of life [2, 3]. In patients who receive NACT and breast reconstruction, the predictive value of clinicopathologic features or treatment-associated factors for LRR is unclear due to a lack of data. Few data are available on the risk factors of locoregional recurrence (LRR) after neoadjuvant chemotherapy (NACT) and immediate breast reconstruction (IBR) in breast cancer. We evaluated the factors predicting LRR in a large series of patients who underwent either nipple- (NSM) or skin-sparing mastectomy (SSM) with IBR after NACT

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