Long-term outcomes of skin-sparing mastectomy and nipple-sparing mastectomy versus traditional mastectomy in breast cancer: a case-control study based on preoperative ultrasound and clinical indicators.
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Abstract
Background and objective: Nipple-sparing mastectomy (NSM) and skin-sparing mastectomy (SSM) are recognized for their aesthetic benefits in breast cancer patients. However, detailed evaluations with large samples of their long-term oncological effectiveness are limited. This study aims to compare the long-term oncologic outcomes of NSM/SSM and traditional mastectomy (TM) in patients with stage I-III breast cancer and to identify influential preoperative factors.
Methods: Among the 12,802 breast cancer patients who underwent surgery from 2009 to 2022 in West China Hospital of Sichuan University, 295 NSM/SSM patients and 584 TM patients were selected after propensity score matching adjusted for variables. Survival outcomes were analyzed using Kaplan-Meier estimates, Fisher's exact test, and log-rank tests, with Cox regression identifying survival predictors.
Results: The median follow-up period was 97.93 months. Local recurrence (LR) was 5.76 ± 1.36% for NSM/SSM compared to 3.25 ± 0.73% for TM (p = 0.076). Overall survival (OS) was comparable (p = 0.601), while disease-free survival (DFS) showed a trend toward significance (p = 0.066). However, there was a significant difference in distant metastasis-free survival (DMFS) (p = 0.029). The 5-year OS rates between the matched groups were similar (98.11% vs. 98.09%, p = 1.000), while the TM group exhibited higher 5-year DFS(95.14% vs. 92.03%, p = 0.335). Following the univariate analysis, multivariate analysis identified significant DFS predictors: stage (HR = 2.701, p = 0.031), radiotherapy (HR = 1.928, p = 0.018), and targeted therapy (HR = 5.584, p < 0.001). For OS, significant predictors included stage (HR = 8.309, p = 0.021) and PR status (HR = 0.35, p = 0.010).
Conclusions: NSM/SSM demonstrated comparable OS and DFS to TM, though with lower DMFS. Preoperative ultrasound parameters showed no significant impact on long-term outcomes, confirming the oncologic safety of NSM/SSM. Tailored adjuvant therapies and appropriate follow-up may further optimize patient prognoses.
期刊介绍：
World Journal of Surgical Oncology publishes articles related to surgical oncology and its allied subjects, such as epidemiology, cancer research, biomarkers, prevention, pathology, radiology, cancer treatment, clinical trials, multimodality treatment and molecular biology. Emphasis is placed on original research articles. The journal also publishes significant clinical case reports, as well as balanced and timely reviews on selected topics.
Oncology is a multidisciplinary super-speciality of which surgical oncology forms an integral component, especially with solid tumors. Surgical oncologists around the world are involved in research extending from detecting the mechanisms underlying the causation of cancer, to its treatment and prevention. The role of a surgical oncologist extends across the whole continuum of care. With continued developments in diagnosis and treatment, the role of a surgical oncologist is ever-changing. Hence, World Journal of Surgical Oncology aims to keep readers abreast with latest developments that will ultimately influence the work of surgical oncologists.
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