Breast-conserving therapy versus postmastectomy breast reconstruction: Propensity score-matched analysis Journal Article
| Authors: | Kim, M.; Tadros, A. B.; Boe, L. A.; Vingan, P.; Allen, R. J. Jr; Mehrara, B. J.; Morrow, M.; Nelson, J. A. |
| Article Title: | Breast-conserving therapy versus postmastectomy breast reconstruction: Propensity score-matched analysis |
| Abstract: | Background: Although studies have compared patient-reported outcomes (PROs) after breast conserving-therapy (BCT) and postmastectomy breast reconstruction (PMBR), they often have been confounded by treatment or other factors that complicate a direct comparison. This study aimed to compare PROs after BCT and PMBR by using propensity score-matching analysis. Methods: Patients who underwent BCT or PMBR between 2010 and 2022 and completed the BREAST-Q were identified. Each BCT patient was matched to a PMBR patient using nearest-neighbor 1:1 matching with replacement for each BREAST-Q time point. Outcomes included all prospectively collected BREAST-Q domains preoperatively, at 6 months, and at 1, 2, and 3 years postoperatively. A 4-point difference was considered clinically meaningful. Results: For this study, 6215 patients (2501 BCT [40.2%] and 3714 PMBR [59.8%] patients) were eligible, and 2616 unique patients were matched. Preoperatively, 463 BCT and 463 PMBR patients were matched for analysis (6 months [443 matched pairs], 1 year [639 matched pairs], 2 years [421 matched pairs], 3 years [254 matched pairs]). At 6 months postoperatively, the BCT patients scored higher on all BREAST-Q domains than the PMBR patients (p < 0.05; differences > 4 points). At 1, 2, and 3 years, the patients who underwent BCT consistently had superior Satisfaction With Breasts, Psychosocial Well-Being, and Sexual Well-Being (p < 0.05), and the differences were clinically meaningful. Conclusion: In this statistically powered study, the BCT patients reported higher quality of life than the PMBR patients in early assessment and also through 3 years of follow-up evaluation. Given the equivalency in survival and recurrence outcomes between BCT and PMBR, patients eligible for either surgery should be counseled regarding the superiority of BCT in terms of PROs. © Society of Surgical Oncology 2024. |
| Keywords: | adult; cancer chemotherapy; middle aged; patient satisfaction; major clinical study; cancer radiotherapy; comparative study; cancer staging; follow up; follow-up studies; antineoplastic agent; prospective study; prospective studies; quality of life; breast cancer; mastectomy; cohort analysis; pathology; breast neoplasms; breast reconstruction; mammaplasty; body mass; breast tumor; partial mastectomy; surgery; intermethod comparison; patient-reported outcomes; patient reported outcome measures; mastectomy, segmental; caucasian; breast-conserving therapy; asian; clinical outcome; breast-conserving surgery; patient-reported outcome; procedures; postmastectomy; postmastectomy breast reconstruction; propensity score; breast-q; humans; prognosis; human; female; article; black person; physical well-being; mskcc score; propensity match |
| Journal Title: | Annals of Surgical Oncology |
| Volume: | 31 |
| Issue: | 12 |
| ISSN: | 1068-9265 |
| Publisher: | Springer |
| Date Published: | 2024-11-01 |
| Start Page: | 8030 |
| End Page: | 8039 |
| Language: | English |
| DOI: | 10.1245/s10434-024-15294-w |
| PUBMED: | 39075246 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledge in the PDF -- Corresponding authors is MSK author: Jonas A. Nelson -- Source: Scopus |
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