TY - JOUR
T1 - Rates of Ipsilateral Local-regional Recurrence in High-risk Patients Undergoing Immediate Post-mastectomy Reconstruction (AFT-01)
AU - Dudley, Christina M.
AU - Wiener, Alyssa A.
AU - Stankowski-Drengler, Trista J.
AU - Schumacher, Jessica R.
AU - Francescatti, Amanda B.
AU - Poore, Samuel O.
AU - Greenberg, Caprice C.
AU - Neuman, Heather B.
N1 - Funding Information:
Supported by the Patient Centered Outcomes Research Institute (PCORI) (Greenberg, Schumacher, Neuman, CE-1304-6543). This publication was further made possible by the National Institute of Health (NIH)-funded University of Wisconsin Carbone Comprehensive Cancer Center Academic Oncologist Training Program (Neuman, NIH 5K12CA087718), Building Interdisciplinary Research Careers in Women's Health Scholar Program (Neuman, NIH K12 HD055894), as well as the National Cancer Institute–funded Surgical Oncology Research Training Program (Wiener, Stankowski-Drengler, T32 CA090217) and the Alliance for Clinical Trials in Oncology (U10CA180821). The data used in the study are derived from a de-identified National Cancer Database file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigator. Further, the contents of this publication are solely the responsibility of the authors and do not necessarily represent the official view of PCORI or NIH.
Funding Information:
Supported by the Patient Centered Outcomes Research Institute (PCORI) (Greenberg, Schumacher, Neuman, CE-1304-6543). This publication was further made possible by the National Institute of Health (NIH)-funded University of Wisconsin Carbone Comprehensive Cancer Center Academic Oncologist Training Program (Neuman, NIH 5K12CA087718), Building Interdisciplinary Research Careers in Women's Health Scholar Program (Neuman, NIH K12 HD055894), as well as the National Cancer Institute–funded Surgical Oncology Research Training Program (Wiener, Stankowski-Drengler, T32 CA090217) and the Alliance for Clinical Trials in Oncology (U10CA180821). The data used in the study are derived from a de-identified National Cancer Database file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigator. Further, the contents of this publication are solely the responsibility of the authors and do not necessarily represent the official view of PCORI or NIH. Financial support for Ms. Dudley's work was provided by a charitable contribution from the Peter and Myra Berk Cristall Breast Cancer Research Fund, which did not influence study design, collection, analysis and interpretation of data, the writing of the report, or the decision to submit the article for publication. The data that support the findings of this study will be available on request from the Alliance for Clinical Trials in Oncology Cancer Care Delivery Research Committee.
Publisher Copyright:
© 2021
PY - 2021/10
Y1 - 2021/10
N2 - Background: Some surgeons remain hesitant to perform immediate breast reconstruction (IBR) in patients with higher risk cancers owing to concerns about cancer recurrence and/or detection. Our objective was to determine the rate of ipsilateral local-regional recurrence for stage II/III patients who underwent IBR. Methods: The National Cancer Database special study mechanism was used to create a stratified sample of women diagnosed with stage II/III breast cancer from 1217 facilities. Demographic, tumor, and recurrence data for women who underwent mastectomy with or without IBR were abstracted, including location of recurrence and method of detection. Estimates of 5-year local-regional recurrence rates were calculated and factors associated with recurrence were identified with multivariable Cox regression. Results: Some 13% (692/5318) of stage II/III patients underwent IBR after mastectomy. Patients undergoing IBR were younger (P < .001), with fewer comorbid conditions (P < .001), and with lower tumor burden in the breast (P = .001) and the lymph nodes (P = 0.01). The 5-year rate of ipsilateral local-regional recurrence was 3.6% with no significant difference between patients with or without IBR (3.0% vs. 3.7%, P = .4). Most recurrences were detected by the patient (45%) or on physician examination (24%). Reconstruction was not associated with recurrence on multivariable analysis (hazard ratio = 0.83, P = .52). Conclusion: Women with stage II/III breast cancer selected for IBR had similar rates of ipsilateral local-regional recurrence compared with those undergoing mastectomy alone. Offering IBR after mastectomy in a patient-centered manner to select patients with stage II/III breast cancer is an acceptable consideration.
AB - Background: Some surgeons remain hesitant to perform immediate breast reconstruction (IBR) in patients with higher risk cancers owing to concerns about cancer recurrence and/or detection. Our objective was to determine the rate of ipsilateral local-regional recurrence for stage II/III patients who underwent IBR. Methods: The National Cancer Database special study mechanism was used to create a stratified sample of women diagnosed with stage II/III breast cancer from 1217 facilities. Demographic, tumor, and recurrence data for women who underwent mastectomy with or without IBR were abstracted, including location of recurrence and method of detection. Estimates of 5-year local-regional recurrence rates were calculated and factors associated with recurrence were identified with multivariable Cox regression. Results: Some 13% (692/5318) of stage II/III patients underwent IBR after mastectomy. Patients undergoing IBR were younger (P < .001), with fewer comorbid conditions (P < .001), and with lower tumor burden in the breast (P = .001) and the lymph nodes (P = 0.01). The 5-year rate of ipsilateral local-regional recurrence was 3.6% with no significant difference between patients with or without IBR (3.0% vs. 3.7%, P = .4). Most recurrences were detected by the patient (45%) or on physician examination (24%). Reconstruction was not associated with recurrence on multivariable analysis (hazard ratio = 0.83, P = .52). Conclusion: Women with stage II/III breast cancer selected for IBR had similar rates of ipsilateral local-regional recurrence compared with those undergoing mastectomy alone. Offering IBR after mastectomy in a patient-centered manner to select patients with stage II/III breast cancer is an acceptable consideration.
KW - Cancer outcomes
KW - Locally-advanced
KW - Reconstruction
KW - Recurrence
KW - breast cancer
UR - http://www.scopus.com/inward/record.url?scp=85108237141&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85108237141&partnerID=8YFLogxK
U2 - 10.1016/j.clbc.2021.03.009
DO - 10.1016/j.clbc.2021.03.009
M3 - Article
C2 - 34103255
AN - SCOPUS:85108237141
SN - 1526-8209
VL - 21
SP - 433
EP - 439
JO - Clinical Breast Cancer
JF - Clinical Breast Cancer
IS - 5
ER -
