Introduction: Neoadjuvant treatment may not provide complete clinical response at the first stage in some patients with skin edema associated with breast cancer. This complicates selection of the subsequent local treatment method. We need to identify predictors that may help personalize the treatment and ensure the best possible long-term outcomes.Purpose: To evaluate long-term outcomes (overall and relapse-free survival) in relation to the sequence of local treatment modalities and identify factors that have the greatest impact on the long-term outcomes of patients with skin edema associated with breast cancer.Material and methods: The publication presents single-factor analysis and long-terms outcomes of 182 patients with persistent skin edema after systemic treatment. The patients were divided into three groups depending on the volume and sequence of local treatment modalities. Group I (n = 91 patient) included patients who received systemic treatment, surgery, and external beam radiotherapy (EBRT). Group II (n = 41) included patients who received only the systemic treatment and EBRT. Group III (n = 50) included patients who received systemic treatment and EBRT followed by resection of the primary tumor.Results: The single-factor analysis showed that progression of breast skin edema after systemic treatment (р = 0.05), long break between the systemic treatment and start of the local treatment (more than 9 weeks, р = 0.028), large number of diseased nodes (р = 0.01), non-pCR (р = 0.013) and lymph nodes (р = 0.014) has a statistically significant effect on the relapse-free survival. The single-factor analysis of the overall survival showed that the most significant factors were age (р = 0.034), degree of therapeutic pathomorphosis in the lymph nodes (р = 0.05), and number of the diseased nodes (р = 0.021).

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Data analysis showed that many diagnostic issues in breast cancer patients with skin involvement are not systematized. In some cases when the tumor is small and skin involvement symptoms are minimal ("local" skin edema), should this category of patients be considered as patients with non-inflammatory skin involvement breast cancer? Current research confirms the presence of skin involvement has much less prognostic value than, for example, tumor size or lymph node metastases, and the surgical term "unresectable" may not always be adequate. In addition, clinical data often do not correspond to pathological data, which also complicates the staging and leads to "overtreatment" of such patients. Thus, further research is needed to identify categories of breast cancer (patients with skin involvement similar in prognosis, as well as to individualize approaches to local and systemic treatment.