Abstract
Oncologic safety of postmastectomy breast reconstruction in young women with breast cancer is not well-defined, especially in the setting of neoadjuvant chemotherapy (NACT). We retrospectively compared the oncologic outcomes following nipple-sparing (NSM)/skin-sparing mastectomy (SSM) with immediate breast reconstruction (IBR) and conventional mastectomy (CM) alone in young breast cancer patients after NACT. A total of 1266 women with primary breast cancer who underwent NACT followed by total mastectomy with or without IBR were reviewed. Of these, only young patients (age ≤ 40years at diagnosis) were included in the outcome analysis (n = 375). After propensity score-matching by clinical T and N stage, molecular subtype, response to NACT, and adjuvant radiotherapy status, 228 patients were 1:1 matched, comprising balanced IBR group (with NSM/SSM) and CM-alone group. The 5-year locoregional recurrence-free, disease-free, distant metastasis (DM)-free, and breast cancer-specific survival (BCSS) rates for the entire cohort of young patients were 83.4%, 65.3%, 71.7%, and 85.4%, respectively. Locoregional recurrence rates between the matched groups were similar (14% vs. 15.8%; p = 0.710); however, IBR group had significantly lower DM rate (27.2% vs. 40.4%; p = 0.036) and breast cancer mortality (14.9% vs. 27.2%; p = 0.023) than CM-alone group. IBR group showed significantly improved 5-year DM-free survival (74.1% vs. 62.6%; p = 0.043) and BCSS (89.1% vs. 77.6%; p = 0.048) rates than CM-alone group. Our results indicated that IBR with NSM/SSM does not negatively affect long-term oncologic outcomes compared to CM alone in young women with breast cancer receiving NACT.
Highlights
The incidence of breast cancer is increasing worldwide [1]
Locoregional recurrence rates between the matched groups were similar (14% vs. 15.8%; P = 0.710); immediate breast reconstruction (IBR) group had significantly lower distant metastasis (DM) rate (27.2% vs. 40.4%; P = 0.036) and breast cancer mortality (14.9% vs. 27.2%; P = 0.023) than conventional mastectomy (CM)-alone group
Our results indicated that IBR with NSM/sparing mastectomy (SSM) does not negatively affect long-term oncologic outcomes compared to CM alone in young women with breast cancer receiving neoadjuvant chemotherapy (NACT)
Summary
The incidence of breast cancer is increasing worldwide [1]. According to the data from GLOBOCAN, approximately 2.2 million women have been newly diagnosed with breast cancer in 2020, accounting for 24.5% of all female malignancies [1]. Young age at diagnosis itself is a prognostic factor associated with adverse breast cancer outcomes [7]. Compared to the older counterparts, younger women with breast cancer are more likely to present with more aggressive tumor characteristics such as higher tumor grade, larger tumor size, higher incidence of nodal involvement, and more lympho-vascular invasion (LVI) [8,9,10]. Oncologic safety of postmastectomy breast reconstruction in young women with breast cancer is not well-defined, especially in the setting of neoadjuvant chemotherapy (NACT). We retrospectively compared the oncologic outcomes following nipple-sparing (NSM)/skin-sparing mastectomy (SSM) with immediate breast reconstruction (IBR) and conventional mastectomy (CM) alone in young breast cancer patients after NACT
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