Daniel I Hoffman1, Patricia Mae G Santos2, Macy Goldbach1, Luke J Keele3, Neil K Taunk2, Hannah S Bogen2, Laura Burkbauer1, Rachel C Jankowitz4, Joshua Fosnot5, Liza C Wu5, Gary M Freedman2, Julia C Tchou6. 1. Division of Endocrine and Oncologic Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. 2. Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. 3. Department of Surgery, Department of Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. 4. Division of Hematology and Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. 5. Division of Plastic Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. 6. Division of Endocrine and Oncologic Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. julia.tchou@pennmedicine.upenn.edu.
Abstract
INTRODUCTION: National guidelines specify against immediate breast reconstruction (IBR) among inflammatory breast cancer (IBC) patients. However, limited data exist regarding this practice. We report practice patterns and oncologic outcomes among nonmetastatic IBC patients receiving trimodality therapy, with or without IBR. METHODS: Using the National Cancer Database, we identified nonmetastatic IBC patients treated with trimodality therapy from 2004 to 2016. Primary outcome was overall survival (OS), assessed on unadjusted analysis using Kaplan-Meier estimates and on adjusted analysis using multivariable Cox proportional hazards and inverse probability weighting (IPW) models. OS analysis was also conducted with propensity score matched (PSM) cohorts. Secondary outcomes included IBR utilization rates, time to postmastectomy radiotherapy (PMRT), and surgical outcomes. RESULTS: 6589 women were included, including 5954 (90.4%) non-reconstructed and 635 (9.6%) IBR. Among IBR recipients, 250 (39.4%) underwent autologous reconstruction, 171 (26.9%) underwent implant-based reconstruction, and 214 (33.7%) unspecified. IBR utilization increased from 6.3% to 10.1% from 2004 to 2016 at a 4% average annual growth rate (P < 0.001). Median follow-up was 43 and 45 months for IBR and non-reconstructed patients, respectively (P = 0.29). On Cox multivariable analysis, IBR was associated with improved OS (HR 0.63, 95% CI 0.44-0.90, P = 0.01), but this association was not significant on IPW analysis (P = 0.06). In PSM cohorts, this association remained significant (HR 0.60, 95% CI 0.40-0.92, P = 0.02). Margin status, time to PMRT, 30-day readmission, and 30-/90-day mortality did not differ between groups (all P > 0.05). CONCLUSION: Although not endorsed by national guidelines, IBR is increasing among IBC patients; however, more granular data are needed to determine oncologic safety.
INTRODUCTION: National guidelines specify against immediate breast reconstruction (IBR) among inflammatory breast cancer (IBC) patients. However, limited data exist regarding this practice. We report practice patterns and oncologic outcomes among nonmetastatic IBC patients receiving trimodality therapy, with or without IBR. METHODS: Using the National Cancer Database, we identified nonmetastatic IBC patients treated with trimodality therapy from 2004 to 2016. Primary outcome was overall survival (OS), assessed on unadjusted analysis using Kaplan-Meier estimates and on adjusted analysis using multivariable Cox proportional hazards and inverse probability weighting (IPW) models. OS analysis was also conducted with propensity score matched (PSM) cohorts. Secondary outcomes included IBR utilization rates, time to postmastectomy radiotherapy (PMRT), and surgical outcomes. RESULTS: 6589 women were included, including 5954 (90.4%) non-reconstructed and 635 (9.6%) IBR. Among IBR recipients, 250 (39.4%) underwent autologous reconstruction, 171 (26.9%) underwent implant-based reconstruction, and 214 (33.7%) unspecified. IBR utilization increased from 6.3% to 10.1% from 2004 to 2016 at a 4% average annual growth rate (P < 0.001). Median follow-up was 43 and 45 months for IBR and non-reconstructed patients, respectively (P = 0.29). On Cox multivariable analysis, IBR was associated with improved OS (HR 0.63, 95% CI 0.44-0.90, P = 0.01), but this association was not significant on IPW analysis (P = 0.06). In PSM cohorts, this association remained significant (HR 0.60, 95% CI 0.40-0.92, P = 0.02). Margin status, time to PMRT, 30-day readmission, and 30-/90-day mortality did not differ between groups (all P > 0.05). CONCLUSION: Although not endorsed by national guidelines, IBR is increasing among IBC patients; however, more granular data are needed to determine oncologic safety.
Authors: Ashley B Simpson; Devina McCray; Craig Wengler; Joseph P Crowe; Risal Djohan; Rahul Tendulkar; Colin O'Rourke; Stephen R Grobmyer; Stephanie A Valente Journal: Ann Surg Oncol Date: 2016-09-08 Impact factor: 5.344
Authors: Kenneth W Hance; William F Anderson; Susan S Devesa; Heather A Young; Paul H Levine Journal: J Natl Cancer Inst Date: 2005-07-06 Impact factor: 13.506
Authors: D J P van Uden; H W M van Laarhoven; A H Westenberg; J H W de Wilt; C F J M Blanken-Peeters Journal: Crit Rev Oncol Hematol Date: 2014-10-16 Impact factor: 6.312
Authors: S Dawood; S D Merajver; P Viens; P B Vermeulen; S M Swain; T A Buchholz; L Y Dirix; P H Levine; A Lucci; S Krishnamurthy; F M Robertson; W A Woodward; W T Yang; N T Ueno; M Cristofanilli Journal: Ann Oncol Date: 2010-07-05 Impact factor: 32.976
Authors: Arjun Menta; Tamer M Fouad; Anthony Lucci; Huong Le-Petross; Michael C Stauder; Wendy A Woodward; Naoto T Ueno; Bora Lim Journal: Surg Clin North Am Date: 2018-05-24 Impact factor: 2.741
Authors: S Dawood; X Lei; R Dent; S Gupta; B Sirohi; J Cortes; M Cristofanilli; T Buchholz; A M Gonzalez-Angulo Journal: Ann Oncol Date: 2014-03-24 Impact factor: 32.976
Authors: P Bonnier; C Charpin; C Lejeune; S Romain; N Tubiana; B Beedassy; P M Martin; H Serment; L Piana Journal: Int J Cancer Date: 1995-08-09 Impact factor: 7.396