medwireNews: Women with breast cancer who undergo immediate breast reconstruction (IBR) with nipple- or skin-sparing mastectomy (NSM or SSM) after neoadjuvant chemotherapy have similar outcomes to those who receive conventional mastectomy, researchers report.
Writing in JAMA Surgery, BeomSeok Ko (University of Ulsan College of Medicine, Seoul, Republic of Korea) and co-authors say that their results highlight “the feasibility of IBR with NSM/SSM” in a neoadjuvant chemotherapy setting.
The retrospective study included data for 323 women with breast cancer who underwent neoadjuvant chemotherapy followed by IBR with NSM (n=187) or SSM (n=136) and 323 women who received neoadjuvant chemotherapy followed by conventional mastectomy alone. The two groups were matched by propensity scoring on the basis of age, clinical T and N category, molecular subtype, and response to neoadjuvant chemotherapy.
After a median follow-up of approximately 5.5 years (67–68 months), the researchers observed no significant differences between the IBR with NSM or SSM and conventional mastectomy groups in the proportions of patients with local recurrence (3.7 vs 3.4%), regional recurrence (7.1 vs 5.3%), or distant metastasis (17.3 vs 18.6%).
In the IBR group, individuals who underwent NSM had similar outcomes to those who underwent SSM, with local recurrence rates of 4.8% versus 2.2%, regional recurrence rates of 7.0% versus 7.4%, and distant metastasis rates of 16.0% versus 19.1%. Recurrence at the nipple–areola complex occurred in 2.1% on patients in the NSM group.
Ko and team also found that there were no significant differences between IBR with NSM or SSM and conventional mastectomy in 5-year rates of local recurrence-free survival (95.6 vs 96.7%), disease-free survival (76.5 vs 79.9%), distant metastasis-free survival (82.5 vs 82.5%), and overall survival (92.0 vs 89.3%).
Furthermore, subgroup analysis among patients who did not respond to neoadjuvant chemotherapy showed no significant differences between the two surgical options in any of the outcomes at 5 years.
This suggests that the response to neoadjuvant chemotherapy “should not be considered a contraindication to IBR and, even in selected patients without response to [neoadjuvant chemotherapy], IBR can be a feasible option and should be discussed before surgical treatment,” Ko et al remark.
In an accompanying comment, Rachel Greenup and co-authors from Duke University Medical Center in Durham, North Carolina, USA, say the study “provides reassurance that acceptable oncologic outcomes might be preserved in the setting of immediate breast reconstruction following [neoadjuvant chemotherapy].”
“Thus, post-[neoadjuvant chemotherapy] surgical decisions should be made in the context of other patient and treatment characteristics that predispose women to perioperative complications and suboptimal outcomes (eg, obesity, history of or potential for future radiotherapy, and smoking),” they add.
The commentators conclude that the data “may further encourage the surgical community to embrace novel advances that allow us to provide high-quality multidisciplinary breast cancer care without losing the outcomes that are important to patients.”
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2020 Springer Healthcare Ltd, part of the Springer Nature Group
JAMA Surg 2020; doi:10.1001/jamasurg.2020.4132
JAMA Surg 2020; doi:10.1001/jamasurg.2020.4138