Comparison of survival outcomes of locally advanced breast cancer patients receiving post-mastectomy radiotherapy with and without immediate breast reconstruction: a population-based analysis

Abstract

ObjectiveTo compare the survival outcomes in locally advanced breast cancer (LABC) patients receiving post-mastectomy radiotherapy (PMRT) with and without immediate breast reconstruction.MethodsWe used the Surveillance, Epidemiology, and End Results program to include LABC patients who were treated/not treated with immediate breast reconstruction followed by PMRT between 2003 and 2010. Statistical analysis was performed using the chi-squared test, Kaplan–Meier survival analysis, and Cox regression analysis. A 1:1 propensity score matching method was performed to decrease the selection bias.ResultsWe identified 1,732 patient-pairs that were completely matched. In the unmatched population, 8,198 and 1,802 patients received mastectomy only and immediate breast reconstruction, respectively. Patients who received immediate breast reconstruction had better breast cancer-specific survival (BCSS) (hazard ratio [HR] 0.880, 95% CI 0.783–0.989, P = 0.032) and overall survival (OS) (HR 0.846, 95% CI 0.758–0.943, P = 0.003) than patients who underwent mastectomy alone. However, in the matched population, there was comparable BCSS and OS between patients who received immediate breast reconstruction and mastectomy alone. Subset analysis in the matched population found that immediate breast reconstruction was associated with better BCSS (HR 0.750, 95% CI 0.614–0.917, P = 0.005) and OS (HR 0.779, 95% CI 0.644–0.942, P = 0.010) compared to patients aged <50 years who received mastectomy alone.ConclusionThere are comparable survival outcomes in LABC patients who received immediate breast reconstruction or mastectomy alone followed by PMRT. However, patients aged <50 years had a survival advantage after immediate breast reconstruction.

Influence of Triple-Negative versus Luminal A Breast Cancer Subtype on Choice of Autologous versus Implant-Based Delayed-Immediate Breast Reconstruction

“…31 Finally, though a selected group of women may choose to pursue no reconstruction after mastectomy, patients should be counseled of associated improved survival in patients undergoing reconstruction compared with no reconstruction, even in locally advanced breast cancer. 32,33…”

Long-term Survival Outcomes in Patients with Locally Advanced Breast Cancer after Total Mastectomy with or without Breast Reconstruction: A Seer-based Analysis

“…The introduction of neoadjuvant chemotherapy has been instrumental in the down-staging of tumors in the management of LABC. This signi cant development has not only made breast reconstruction, utilizing either implants or autologous tissue, a routine procedure for LABC patients [11], but has also contributed to the increased prevalence and safety of breast-conserving surgery, regardless of whether the LABC presentation is non-in ammatory or in ammatory [12] [13]. Researches has provided evidence that an increasing number of patients diagnosed with LABC are opting for immediate breast reconstruction, particularly following the year 2004 [14].…”

Locally advanced breast cancer patients should be cautious about the immediate breast reconstruction after mastectomy: a pooling analysis of safety and efficacy

“…(2) single-arm cohort studies. Two studies [ 21 , 22 ] both used SEER database but included different population and were both included in our analysis.…”