Is Oncoplastic Surgery Safe in High‐Risk Breast Cancer Phenotypes?

IF 2 3区医学 Q3 ONCOLOGY

Journal of Surgical Oncology Pub Date : 2024-09-17 DOI:10.1002/jso.27899

Gabriel De La Cruz Ku, Carly Wareham, Caroline King, Akash Koul, Anshumi Desai, Sarah M. Persing, Salvatore Nardello, Abhishek Chatterjee

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引用次数: 0

Abstract

BackgroundOncoplastic surgery (OPS) has increased in popularity over the recent years. It is a form of breast conservation surgery allowing for larger partial mastectomy (PM) resections followed by either volume displacement or volume replacement reconstruction techniques. However, there is a lack of evidence on the effectiveness and safety of OPS with radiotherapy (OPS + RT) in high‐risk breast cancer phenotypes, such as triple negative breast cancer (TNBC) and HER2 positive (HER2+) patients. Our aim was to compare the breast cancer‐specific survival (BCSS) and postoperative surgical complications in OPS + RT compared to PM alone with radiation (PM + RT) and total mastectomy (MTX) without radiotherapy (MTX‐RT).MethodsPatient data were analyzed from the Surveillance, Epidemiology, and End Results (SEER) cancer registries from January 1, 2012 to December 31, 2020. Patients were stratified according to the type of surgery. Cox regression analysis was performed to assess prognostic factors of BCSS.ResultsA total of 24 621 patients with high‐risk breast cancer phenotypes were identified, 180 underwent OPS + RT; 13 402, PM + RT; and 11 039 MTX‐RT. OPS + RT was more frequently performed in younger (mean age of 65.53 years, SD: 9.29, p < 0.001), non‐Hispanic White (90.5% vs. 77.7% vs. 76.3%) and single women (17.9% vs. 12.1% vs. 13.3%). MTX‐RT was usually performed in patients with high histological grade, TNBC, and higher stages. Overall complication rates were higher in the MTX‐RT, compared to OPS + RT and PM + RT, 2%, 1.1%, and 0.7%, respectively, p < 0.001. Rates of hematoma and surgical site infections were higher in the MTX‐RT group. With a median follow‐up of 46 months, OPS + RT had better BCSS rates at 5 years compared to PM + RT and MTX‐RT (97.1% vs. 94.7% vs. 89.8%, p < 0.001). MTX‐RT was found to be an independent prognostic factor of worse BCSS compared to OPS + RT (hazard ratio [HR] = 2.584; 95% confidence interval [CI]: 1.005–7.171), while PM + RT had no difference compared to OPS + RT (HR = 1.670, 95% CI: 0.624–4.469).ConclusionsOPS is a safe breast surgical option in patients with HER2+ and TNBC. Patients with high‐risk phenotypes who underwent OPS + RT and have similar BCSS and complication rates compared to standard breast surgical options. As such, OPS should be considered as an option whenever breast conservation surgery is being discussed.

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肿瘤整形手术对高危乳腺癌患者安全吗？

背景近年来，乳房整形手术（Oncoplastic surgery，OPS）越来越受欢迎。它是一种乳房保护手术，可进行较大的乳房部分切除术（PM），然后采用体积置换或体积替代重建技术。然而，对于三阴性乳腺癌（TNBC）和HER2阳性（HER2+）患者等高危乳腺癌表型，OPS+放疗（OPS+RT）的有效性和安全性还缺乏证据。我们的目的是比较OPS+RT与单纯PM+放疗（PM+RT）和全乳房切除术（MTX）+放疗（MTX-RT）相比的乳腺癌特异性生存率（BCSS）和术后手术并发症。方法对2012年1月1日至2020年12月31日期间来自监测、流行病学和最终结果（SEER）癌症登记处的患者数据进行分析。根据手术类型对患者进行了分层。结果共发现24 621例高风险乳腺癌患者，其中180例接受了OPS+RT；13 402例接受了PM+RT；11 039例接受了MTX-RT。更多年轻（平均年龄 65.53 岁，SD：9.29，p < 0.001）、非西班牙裔白人（90.5% vs. 77.7% vs. 76.3%）和单身女性（17.9% vs. 12.1% vs. 13.3%）接受了 OPS + RT。MTX-RT通常用于组织学分级高、TNBC和分期较高的患者。与OPS + RT和PM + RT相比，MTX-RT的总体并发症发生率更高，分别为2%、1.1%和0.7%，P< 0.001。MTX-RT组的血肿和手术部位感染率更高。中位随访时间为46个月，与PM + RT和MTX-RT相比，OPS + RT在5年内的BCSS率更高（97.1% vs. 94.7% vs. 89.8%，p <0.001）。与OPS + RT相比，MTX-RT是BCSS恶化的独立预后因素（危险比[HR] = 2.584；95%置信区间[CI]：1.005-7.171），而PM + RT与OPS + RT相比没有差异（HR = 1.670，95% CI：0.624-4.469）。与标准乳腺手术方案相比，接受OPS+RT的高风险表型患者的BCSS和并发症发生率相似。因此，无论何时讨论保乳手术，都应将 OPS 作为一种选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Surgical Oncology 医学-外科

CiteScore

4.70

自引率

4.00%

发文量

367

审稿时长

2 months

期刊介绍： The Journal of Surgical Oncology offers peer-reviewed, original papers in the field of surgical oncology and broadly related surgical sciences, including reports on experimental and laboratory studies. As an international journal, the editors encourage participation from leading surgeons around the world. The JSO is the representative journal for the World Federation of Surgical Oncology Societies. Publishing 16 issues in 2 volumes each year, the journal accepts Research Articles, in-depth Reviews of timely interest, Letters to the Editor, and invited Editorials. Guest Editors from the JSO Editorial Board oversee multiple special Seminars issues each year. These Seminars include multifaceted Reviews on a particular topic or current issue in surgical oncology, which are invited from experts in the field.