Oncological Safety And Prognosis Factors Analysis Of Immediate Breast Reconstruction After Nipple-areola-complex Sparing Mastectomy

ObjectiveTo compare the prognosis between immediate breast reconstruction after nipple-areola complex(NAC)sparing mastectomy(NSM+IBR)andimmediate breast reconstruction after modified radical mastectomy(MRM+IBR)in early stage breast cancer patients,analyze oncological safetyof NSM+IBR,as well as the prognostic factors.MethodsThe complete clinical data of 193 cases,including I-IIa breast cancer patients who had undergone NSM+IBR(118 cases)and MRM+IBR(75 cases)in Tianjin Tumor Hospital from January 2004 to December 2015,were carefully collected.In addition to the prognosis of these two groups,the prognostic factors were also retrospectively analyzed.The clinical features datas of two groups count compare by x~2 test,measurement datas count compare by Kaplan-Meier method.The difference in survival was tested by Log rank test and multivariate analysis was taken as Cox model.P<0.05 for the difference was statistically significant.ResultsIn the NSM+IBR group,patients were followed-up for a period ranging from 13to 149 months with a median of 53 months.The local recurrence,distant metastasis,death and NAC necrosis occurred in 4,6,9 and 4 cases,respectively during 3 years after operation.The local recurrence rate(LRR)was 3.4%,3year disease-free survival(DFS)rate was 91.5%,the overall survival(OS)rate was 92.4%.In the MRM+IBR group,patients were followed-up for a period ranging from 11 to 140months with a median of 51 months.The local recurrence,distant metastasis,and death occurred in 1,4,and 3 cases,respectivelyduring 3 years after operation.The LRRwas 1.3%,3year DFS was 93.3%whereas the OSrate was 96.0%.The 3year DFS and OS rates of the MRM+IBR group were both higher than the NSM+IBR group whereas the LRR was lower than NSM+IBR group.However,no statistical differencewasnotedbetweenthetwogroups(x~2=0.768,p=0.381;x~2=0.209,p=0.647;x~2=1.035,p=0.309).The analysis of prognostic correlation factors in the NSM+IBR group patients shows that HER2 positive and molecular type correlated with the 3year DFS(P<0.05)independently and molecular type correlated with OS(P<0.05)independently.ConclusionNSM dose not have bad effect on the prognosis and could ensure oncological safetyof early stage breast cancer patients.IBR could improve female patients’figure and ensure the quality of life.HER2 positive and molecular type are the independent prognosis factors of the 3year DFS(P<0.05),molecular type is the independent prognosis factor of OS(P<0.05).NSM not only resembles the classic modified radical mastectomy more than MRM in resection scope,but also can keep breast skin and NAC at the same time,and maintain the external body shape of patients well,reduce the psychological pressure and improve the quality of life of patients.