Prognosis Comparison Between Nipple-Sparing Mastectomy and Total Mastectomy in Breast Cancer: A Case-Control Study After Propensity Score Matching

Abstract

Background Currently, the operation rate of nipple-sparing mastectomy (NSM) is increasing. However, the long-term prognosis of NSM is not well documented. We utilized the Surveillance, Epidemiology, and End Results (SEER) database to analyze the long-term prognosis of NSM compared with total mastectomy (TM). Methods Population-level data of female breast cancer patients treated with NSM and TM were extracted from 1998 to 2016 from the SEER database. Propensity score matching (PSM) was performed to reduce the influence of selection bias and confounding variables in comparisons. Kaplan-Meier analysis, log-rank test, and Cox proportional hazard regression were performed. Results A total of 5765 patients underwent NSM, which increased from 266 in 2004–2009 to 5370 in 2010–2016. A total of 134,528 patients underwent TM, and the number of patients undergoing TM continued to decline. The overall survival (OS) and breast cancer-specific survival (BCSS) were similar between the NSM group and the TM group (P = 0.058 and 0.87, respectively). For OS, subgroup analysis showed that patients with age ≥ 46, White race, median household income ≥ $70,000, hormone receptor-positive, and HER2 negative had a better prognosis for treatment with NSM. There was no significant difference in BCSS between the NSM group and the TM group. Conclusions In recent years, the clinical application of NSM has been increasing. NSM is a proper procedure for breast cancer patients to achieve long-term survival.

Careful Where You Cut: Strategies for Successful Nerve-preserving Mastectomy

“…Although numerous publications have reported improved outcomes with breast neurotization, results can vary due to differences in techniques. [1][2][3][4][5][6][7][8][9][10][11][12]18,19 The combination of nerve-sparing mastectomy and breast neurotization with autografts or allografts may enhance sensory recovery in the breast. For reliable evaluation of outcomes, standardization of nervesparing mastectomy and NAC neurotization techniques is essential.…”

“…Importantly, longterm follow-up studies over 5, 10, and 15 years reveal that NSM demonstrates no significant differences in overall survival or breast cancer-specific survival when compared with total mastectomy, thus affirming its oncological safety. 1,2 Although NSM offers remarkable cosmetic benefits by preserving the nipple, it is not without its challenges. Many patients express disappointment due to the diminished sensation and numbness that often follows the procedure.…”

“…Importantly, long-term follow-up studies over 5, 10, and 15 years reveal that NSM demonstrates no significant differences in overall survival or breast cancer-specific survival when compared with total mastectomy, thus affirming its oncological safety. 1 , 2 …”

Prognosis comparison between intraoperative radiotherapy and whole-breast external beam radiotherapy for T1–2 stage breast cancer without lymph node metastasis treated with breast-conserving surgery: A case–control study after propensity score matching

“…Studies based on the SEER database have a high clinical reference value because of large sample size and strong statistical efficacy. We have previously explored the impact of chemotherapy on the prognosis of patients with metaplastic breast carcinoma (MpBC) and compared the long-term prognosis of nipple-sparing mastectomy (NSM) vs. total mastectomy (TM) by analyzing different populations in the SEER database, providing large sample-based evidence for breast cancer treatment ( 39 , 40 ).…”

Prognostic Model and Influencing Factors for Breast Cancer Patients

“…Regarding the effect of treatment modality, existing studies have focused on the effect of surgical modality and radiotherapy on patient survival. Several studies have found that breast-conserving mastectomy is an appropriate approach to achieve long-term survival in breast cancer patients than total mastectomy [10][11][12]. Wang et al [13] found that chemotherapy was not an important factor in survival, but patients with hormone receptor HR-positive high-risk breast cancer may benefit from chemotherapy.…”