Local recurrence is frequent after heroic mastectomy for classically inoperable breast cancers Journal Article
| Authors: | Mamtani, A.; Sevilimedu, V.; Vincent, A.; Morrow, M. |
| Article Title: | Local recurrence is frequent after heroic mastectomy for classically inoperable breast cancers |
| Abstract: | Background: Despite advances in neoadjuvant systemic therapy (NST), some patients with aggressive T4 breast cancers do not respond. The efficacy of ‘heroic’ mastectomy in maintaining local control is unclear. Methods: In consecutive patients with primary or recurrent T4 cancers with < 50% shrinkage on NST who underwent mastectomy from 2007 to 2017, clinicopathologic characteristics and locoregional recurrence (LRR) were examined. Results: Among 104 patients, 59 (57%) had primary T4M0, 12 (12%) had locally recurrent T4M0, and 33 (32%) had T4M1 disease. Median age was 58.5 years and the majority had high-grade (74%) ductal cancers (85%); 45 (44%) were estrogen receptor-positive/human epidermal growth factor receptor 2-negative (ER+/HER2−), 26 (25%) were HER2 positive (HER2+), and 31 (30%) were triple negative (TN). Postoperative complications developed in 41 (39%) patients. At a median follow-up of 37 months, 42 (40%) patients developed LRR. TN (hazard ratio [HR] 7.5) and HER2+ (HR 2.67) subtypes, lymphovascular invasion (LVI; HR 3.80), and positive margins (HR 4.09) were predictive of LRR. The 3-year LRR rate was highest and overall survival (OS) was lowest among patients with TN cancers, at 66% (95% confidence interval [CI] 48–83%) and 30% (95% CI 14–47%), respectively. Conclusions: After heroic mastectomy, postoperative complications were frequent and LRR occurred in 40% of patients despite a median OS of 3.8 years. Among TN patients, the 3-year LRR rate of 66% and 3-year OS of 30% suggest limited surgery benefit. Careful patient selection is prudent when considering heroic mastectomy. © 2021, Society of Surgical Oncology. |
| Keywords: | adult; aged; middle aged; primary tumor; retrospective studies; major clinical study; overall survival; cancer recurrence; neoadjuvant therapy; cancer staging; follow up; neoplasm staging; neoplasm recurrence, local; breast cancer; mastectomy; epidermal growth factor receptor 2; pathology; breast neoplasms; retrospective study; postoperative complication; tumor recurrence; breast tumor; receptor, erbb-2; inoperable cancer; triple negative breast cancer; local recurrence free survival; estrogen receptor positive breast cancer; human epidermal growth factor receptor 2 positive breast cancer; humans; human; female; article; simple mastectomy; breast ductal carcinoma; human epidermal growth factor receptor 2 negative breast cancer |
| Journal Title: | Annals of Surgical Oncology |
| Volume: | 29 |
| Issue: | 2 |
| ISSN: | 1068-9265 |
| Publisher: | Springer |
| Date Published: | 2022-02-01 |
| Start Page: | 1043 |
| End Page: | 1048 |
| Language: | English |
| DOI: | 10.1245/s10434-021-10764-x |
| PUBMED: | 34522999 |
| PROVIDER: | scopus |
| PMCID: | PMC9422616 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 February 2022 -- Source: Scopus |
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