We compared the prognosis of patients with breast cancer according to surgical options including mastectomy with reconstruction after neoadjuvant chemotherapy (NAC). We also assessed the association between prognosis and surgical options according to clinical stage and clinical response in patients with neoadjuvant chemotherapy.
A total of 140,712 patients were enrolled in the Korean Breast Cancer Society Registry database between 2000 and 2014 in Korea. We compared the prognosis of three groups; 1) patients who underwent breast-conserving surgery (BCS), 2) patients who underwent mastectomy, and 3) patients who underwent mastectomy with reconstruction.
Of all 6,634 patients who were treated with NAC, 1,745 patients underwent BCS, 1,459 patients underwent mastectomy, and 363 patients underwent mastectomy with reconstruction. In survival analysis, five-year survival rate (5YSR) of mastectomy with BR group was not inferior compare to other groups in clinical stage IIA and IIB. 5YSR of mastectomy with BR group was 100% and 90.0% clinical stage IIA and IIB, whereas 5YSR of mastectomy group was 97.2% and 86.2% (clinical stage IIA and IIB; P = 0.033 and 0.023). In clinical stage IIIA and IIIB, there was no significant difference in 5YSR between mastectomy with BR group and other groups. However, women who underwent mastectomy with BR had a worse prognosis compare to BCS or mastectomy group in clinical stage IIIC. In univariate analysis by Cox regression method according to surgical methods, women who underwent mastectomy with BR had a worse prognosis compared to other groups in patients with clinical stage IIIC (HR 5.88; 95% CI 2.17-15.89; P < 0.001). In multivariate analysis, women who underwent mastectomy with reconstruction followed by NAC were associated with a worse prognosis in clinical stage IIIC. (HR 3.41; 95% CI 1.29-8.99; P = 0.013).
In this study, women who underwent mastectomy with reconstruction followed by NAC were associated with a worse prognosis in the clinically advanced stage. This study suggests that reconstruction followed by NAC should be considered for appropriately selected patients.
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