Comparative effectiveness of nipple-sparing mastectomy and breast-conserving surgery on long-term prognosis in breast cancer

Qitong Chen; Limeng Qu; Yeqing He; Yueqiong Deng; Qin Zhou; Wenjun Yi

doi:10.3389/fendo.2023.1222651

Comparative effectiveness of nipple-sparing mastectomy and breast-conserving surgery on long-term prognosis in breast cancer

Front Endocrinol (Lausanne). 2023 Nov 20:14:1222651. doi: 10.3389/fendo.2023.1222651. eCollection 2023.

Authors

Qitong Chen^{1

2}, Limeng Qu^{1

2}, Yeqing He^{1

2}, Yueqiong Deng^{1

2}, Qin Zhou^{1

2}, Wenjun Yi^{1

2}

Affiliations

¹ Department of General Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
² Clinical Research Center for Breast Disease in Hunan Province, Changsha, Hunan, China.

Abstract

Background: The frequency of nipple-sparing mastectomy (NSM) surgery is presently increasing. Nonetheless, there is a paucity of long-term prognosis data on NSM. This study compared the long-standing prognosis of NSM in relation to breast-conserving surgery (BCS).

Methods: Population-level data for 438,588 female breast cancer patients treated with NSM or BCS and postoperative radiation from 2000 to 2018 were identified in the Surveillance, Epidemiology, and End Results (SEER) database; 321 patients from the Second Xiangya Hospital of Central South University were also included. Propensity score matching (PSM) was performed to reduce the influence of selection bias and confounding variables to make valid comparisons. The Kaplan-Meier analysis, log-rank test, and Cox regression were applied to analyze the data.

Results: There were no significant differences in long-term survival rates between patients who underwent NSM and those who underwent BCS+radiotherapy (BCS+RT), as indicated by the lack of significant differences in overall survival (OS) (p = 0.566) and breast cancer-specific survival (BCSS) (p = 0.431). Cox regression indicated that NSM and BCS+RT had comparable prognostic values (p = 0.286) after adjusting for other clinicopathological characteristics. For OS and BCSS, subgroup analysis showed that the majority of patients achieved an analogous prognosis whether they underwent NSM or BCS. The groups had comparable recurrence-free survival (RFS), with no significant difference found (p = 0.873).

Conclusions: This study offers valuable insights into the long-term safety and comparative effectiveness of NSM and BCS in the treatment of breast cancer. These findings can assist clinicians in making informed decisions on a case-by-case basis.

Keywords: Surveillance Epidemiology and End Results (SEER); breast cancer; breast-conserving surgery (BCS); nipple-sparing mastectomy (NSM); propensity score matching (PSM).

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Breast Neoplasms* / pathology
Female
Humans
Mastectomy / adverse effects
Mastectomy / methods
Mastectomy, Segmental / methods
Nipples / pathology
Nipples / surgery
Prognosis

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was funded by the Science and Technology Innovation Program of Hunan Province (Grant No. 2021SK2026), the Clinical Medical Boot Technology Innovation Project of Hunan Province (Grant No. 2021SK53504), the Health and Family Planning Commission of Hunan Province (Grant No. 2022JJ70143), the Innovation Platform and Talent Plan of Hunan Province (2023SK4019), the Clinical Research Special Fund of Wu Jieping Medical Foundation (Grant No. 320.6750.2022-19-29), and the National Natural Science Foundation of China (Grant Nos. 82270834 and 82000756).