Comparison of long-term oncological outcomes after central lumpectomy versus nipple-sparing breast-conserving surgery for centrally located breast cancer: a propensity score-matched study

Abstract

Purpose To compare the oncological safety of nipple-sparing breast-conserving surgery (BCS) versus central lumpectomy for centrally located breast cancer (CLBC). Methods Patients who underwent BCS for CLBC at Asan Medical Center from 2007 to 2018 were reviewed retrospectively. The oncological outcomes of nipple-sparing BCS (NS-BCS) and central lumpectomy were compared using univariate and multivariate Cox regression analyses and compared again after 1:1 propensity score matching (PSM). Results The study included 309 patients who underwent NS-BCS and 107 patients who underwent central lumpectomy (median follow-up: 111 months). On multivariate analysis, central lumpectomy had a lower risk of local recurrence compared to NS-BCS, albeit without statistical significance (HR 0.16, 95% CI 0.02–1.23, p = 0.078). There was no significant difference in the risk of death (HR 0.21, 95% CI 0.03–1.70, p = 0.14). After PSM, each group had 107 patients. The 5-year and 10-year local recurrence-free survival rates were 96.2% and 94.8% for NS-BCS, and 99.1% and 99.1% for central lumpectomy, respectively (p = 0.059). There were no significant differences in overall survival, regional recurrence-free survival, or distant recurrence-free survival. Fifteen patients (4.9%) who underwent NS-BCS had ipsilateral breast tumor recurrence (IBTR), of which 40% were in the nipple-areolar complex and previous surgical sites. One patient (0.9%) who underwent central lumpectomy experienced an IBTR in a different quadrant. Conclusion NS-BCS showed more local recurrence than central lumpectomy, albeit without statistical significance. When deciding whether to spare the nipple during BCS in CLBC, patients should be sufficiently informed about the risk of IBTR.