Breast Cancer Oncological Outcomes at an Italian Center Following Nipple-Sparing and Skin-Sparing Mastectomy Techniques (original) (raw)

Clinical and Experimental Obstetrics & Gynecology

Background: The introduction of skin-sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) with immediate reconstruction allowed a noticeable improvement in reconstructive surgery aesthetic results and patients' psychophysical well-being. In any case, there are still concerns about the long-term oncological safety of these two procedures. This study aims to assess the oncological outcomes of women who underwent SSM and NSM and to compare them with traditional modified total mastectomy (MTM). The secondary outcome was to compare mastectomy with breast-conserving surgery (BCS) outcome. Methods: We performed a retrospective chart review study concerning all patients who had experienced SSM and NSM in our Clinic between January 2004 and July 2013. The main outcomes were overall survival (OS), disease-free survival (DFS), and recurrences cumulative rate. Results: Among this study's 1836 invasive breast carcinomas, we found NSM (86.7, 95% confidence interval (CI), 76.7-98.0%) to have a significantly shorter 5-year DFS than MTM (90.4%, 95% CI, 87.9-93.0%). Furthermore, low body mass index (odds ratio (OR) 0.733, p = 0.056), basal-like molecular subtype (OR 28.932, p < 0.05), extended intraductal component (OR 11.160, p = 0.107), and lymph node metastasis extracapsular invasion (OR 8.727, p = 0.077) were the most significant predictors of recurrence in women treated with NSM. Furthermore, patients with BCS had significantly longer OS and DFS than those who underwent MTM. Conclusions: Occult nipple neoplastic involvement following negative intraoperative histological examination of subareolar tissue may explain the higher recurrence rate among women undergoing NSM. Patients with one or more risk factors for recurrence after NSM, such as basal-like molecular subtype, extended intraductal component, and extracapsular invasion of lymph node metastasis, should be given special attention. Keywords: breast cancer; nipple-sparing mastectomy; skin-sparing mastectomy; disease-free survival; breast-conserving surgery; modified total mastectomy; overall survival; local recurrence Table 1. Population description and treatment. Variables All (1836) BCS (49%; 899/1836) NSM (4.7%; 87/1836) SSM (10.7%; 196/1836) MTM (35.6%; 654/1836) p(*) Woman age at surgery (years) 59.14 (±12.36) 59.36 (±11.00) 51.17 (±10.21) 52.95 (±10.27) 61.77 (±13.80) 1,2,3,5,6 BMI (kg/m 2) 25.71 (±4.96) 25.89 (±4.86) 24.18 (±4.06) 24.36 (±4.01) 26.05 (±5.35) 1,2,5,6 Follow up time (months) 66 (34-98) 67.89 (±45.54) 29.10 (±20.52) 75.34 (±41.65) 75.43 (±52.38) 1,2,3,4,5 Tobacco smoke 6.4% (118/1836) 6.85% (49/715) 1.82% (1/55) 11.04% (18/163) 9.43% (50/530) 4 Familial history of cancer 12.8% (235/1836) 34.86% (114/327) 40.43% (19/47) 44.62% (29/65) 38.62% (73/189) NS Use of estrogen/progesteron pills 6% (111/1836) 33.33% (60/180) 42.86% (6/14) 34.88% (15/43) 24.39% (30/123) NS Post-menopausal status 77.8% (1429/1836) 82.76% (744/899) 50.57% (44/87) 60.20% (118/196) 80.21% (523/652) 1,2,5,6 Definitive axilla surgrery CALND 49.6% (911/1836) 30.92% (278/899) 33.33% (29/87) 49.49% (97/196) 77.52% (507/654) 2,3,4,5,6 SLNB 50.4% (925/1836) 69.08% (621/899) 66.67% (58/87) 50.51% (99/196) 22.48% (147/654) 2,3,4,5,6 Non surgical therapy Neoadjuvant chemotherapy 5.6% (102/1836) 3.34% (30/899) 0.00% (0/87) 5.10% (10/196) 9.48% (62/654) 3,4,5 Adjuvant radiotherapy 54.5% (1000/1836) 92.40% (814/881) 11.90% (10/84) 16.49% (31/188) 22.52% (145/644) 1,2,3,5 Adjuvant chemotherapy 41.1% (755/1836) 31.78% (280/881) 54.76% (46/84) 58.51% (110/188) 49.53% (319/644) 1,2,3,6 Adjuvant hormonal therapy 78.4% (1439/1836) 84.11% (741/881) 76.19% (64/84) 77.13% (145/188) 75.93% (489/644) 2,3 (*) Significant differences with a p-value < 0.05 between the following groups: (1) BCS vs NSM; (2) BCS vs SSM; (3) BCS vs MTM; (4) NSM vs SSM; (5) NSM vs MTM; (6) SSM vs MTM. NS, non-significant differences.