Anna Weiss1, Carrie K Chu2, Heather Lin3, Yu Shen3, Simona F Shaitelman4, Patrick Bryan Garvey2, Isabelle Bedrosian5, Gildy V Babiera5. 1. Department of Surgical Oncology, Brigham and Women's Hospital, Boston, MA, USA. aweiss5@bwh.harvard.edu. 2. Plastic Surgery, UT MD Anderson, Houston, TX, USA. 3. Department of Biostatistics, UT MD Anderson, Houston, TX, USA. 4. Radiation Oncology, UT MD Anderson, Houston, TX, USA. 5. Breast Surgical Oncology, UT MD Anderson, Houston, TX, USA.
Abstract
PURPOSE: Modern treatments are prolonging life for metastatic breast cancer patients. Reconstruction in these patients is controversial. The purpose of this study was to characterize de novo metastatic breast cancer patients who undergo mastectomy and reconstruction and to report complication and survival rates. METHODS: We queried the National Cancer Database for de novo metastatic breast cancer patients, who underwent systemic therapy and mastectomy with reconstruction (R) or without reconstruction (NR) between 2004 and 2013. Patient-tumor characteristics, mortality, and readmissions were compared. Propensity score matched analysis was performed, and survival was calculated using the Kaplan-Meier method. RESULTS: A total of 8554 patients fulfilled study criteria (n = 980/11.5% R vs. n = 7574/88.5% NR). There was a significant increase in reconstruction rates by year: 5.2% in 2004, 14.3% in 2013 (p < 0.0001). Compared with the NR patients, R patients were younger (mean age 49 vs. 58 years, p < 0.0001), more hormone receptor-positive (76.1% vs. 70.5%, p = 0.0004), had lower grade disease (p = 0.0082), and fewer sites of metastases (85.7% had 1 metastasis; 14.3% had ≥ 2 R vs. 79% had 1; 21% had ≥ 2 NR, p = 0.0002). R patients received more hormonal and chemotherapy than NR but equally received radiation. Median overall survival of the total cohort was 45 months, and median overall survivals of R and NR groups by matched analysis were 56.7 and 55.3 months respectively (p = 0.86). Thirty-day mortality (0.2%-R, 0.3%-NR, p = 0.56) and readmissions (5.9%-R, 5.8%-NR, p = 0.81) were similar; 90-day mortality also was similar (1.1%-R vs. 1.6%-NR, p = 0.796). CONCLUSIONS: There is an increasing trend to reconstruct metastatic breast cancer patients with low complication rates, without survival compromise. Impact on quality of life warrants further assessment.
PURPOSE: Modern treatments are prolonging life for metastatic breast cancerpatients. Reconstruction in these patients is controversial. The purpose of this study was to characterize de novo metastatic breast cancerpatients who undergo mastectomy and reconstruction and to report complication and survival rates. METHODS: We queried the National Cancer Database for de novo metastatic breast cancerpatients, who underwent systemic therapy and mastectomy with reconstruction (R) or without reconstruction (NR) between 2004 and 2013. Patient-tumor characteristics, mortality, and readmissions were compared. Propensity score matched analysis was performed, and survival was calculated using the Kaplan-Meier method. RESULTS: A total of 8554 patients fulfilled study criteria (n = 980/11.5% R vs. n = 7574/88.5% NR). There was a significant increase in reconstruction rates by year: 5.2% in 2004, 14.3% in 2013 (p < 0.0001). Compared with the NR patients, R patients were younger (mean age 49 vs. 58 years, p < 0.0001), more hormone receptor-positive (76.1% vs. 70.5%, p = 0.0004), had lower grade disease (p = 0.0082), and fewer sites of metastases (85.7% had 1 metastasis; 14.3% had ≥ 2 R vs. 79% had 1; 21% had ≥ 2 NR, p = 0.0002). R patients received more hormonal and chemotherapy than NR but equally received radiation. Median overall survival of the total cohort was 45 months, and median overall survivals of R and NR groups by matched analysis were 56.7 and 55.3 months respectively (p = 0.86). Thirty-day mortality (0.2%-R, 0.3%-NR, p = 0.56) and readmissions (5.9%-R, 5.8%-NR, p = 0.81) were similar; 90-day mortality also was similar (1.1%-R vs. 1.6%-NR, p = 0.796). CONCLUSIONS: There is an increasing trend to reconstruct metastatic breast cancerpatients with low complication rates, without survival compromise. Impact on quality of life warrants further assessment.
Authors: Murad J Karadsheh; Jacob Y Katsnelson; Karen J Ruth; Eric S Weiss; James C Krupp; Elin R Sigurdson; Richard J Bleicher; Marilyn Ng; M Shuja Shafqat; Sameer A Patel Journal: Plast Reconstr Surg Glob Open Date: 2021-04-15
Authors: Francesca Santori; Gianluca Vanni; Oreste Claudio Buonomo; Adriano De Majo; Maurizio Rho; Alessandra Vittoria Granai; Marco Pellicciaro; Maria Cotesta; Massimo Assogna; Rolando Maria D'Angelillo; Marco Materazzo Journal: Int J Surg Case Rep Date: 2020-06-20