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Abstract
Aim. Improvement in oncological outcomes in stage I-II breast cancer following subcutaneous/skin-sparing mastectomy with reconstruction.
Materials and Methods. From 2013 to 2022, 984 patients diagnosed with breast cancer underwent 1020 subcutaneous/skin-sparing mastectomies with reconstruction at the P. Hertsen Moscow Oncology Research Institute (MORI). Subcutaneous mastectomy with reconstruction was performed in 617 (60.5 %) cases and skin-sparing mastectomy in 403 (39.5 %) cases. Autologous reconstruction was performed in 5.7 % of patients and expanders/implants in 94.3 % of patients.
Results. The recurrence rate was 3.7 % and the incidence of distant metastases was 5.2 % in the group of patients studied. In a single factor analysis, recurrence was diagnosed in 5.1 % at stage I, 2.0 % at stage IIA, 3.5 % at stage IIA, and 2.2 % at stage IIB (р ˃ 0,05). The recurrence rate in the radiation therapy group was 2.5 (OR 0.98, CI 1.52-3.48, 95 %) and 4.9 % (OR 2.13, CI 0.92-5.18, 95 %) without radiation therapy, regardless of breast cancer stage. The dependence of breast cancer recurrence on lymph node damage is as follows: in N0 - 3.9 %, with metastatic lesion of 1 lymph node - 3.1 %, with metastatic lesion of 2 lymph nodes - 2.6 %, with lesion of 3 lymph nodes, no relapses were diagnosed. The recurrence rate was 2 % (OR 0.54, 1.46-2.54, 95 %) in the neoadjuvant polychemotherapy (NAPCT) group and 4.1 % (OR 2.35, 2.27-2.43, 95 %) without NAPCT.
Conclusion. The recurrence rate in the radiation therapy group was 2.5 ± 0.6 (OR 0.98, CI 1.52-3.48, 95 %) and 5.1 % (OR 2.13, CI 0.92-5.18, 95 %) without radiation therapy, regardless of breast cancer stage (criterion T > 2, р ˂ 0,05. In our study, breast cancer recurrence at the margin of R1 was 6.8 ± 2.5 %, at R0 – 3 ± 0.6 % (p > 0.05). Recurrence of triple-negative breast cancer was diagnosed in 2.5 ± 0.9 % compared to other molecular biological types (criterion T = 1.49, p > 0.05). Apart from radiation therapy, a statistically significant difference was found with NAPCT when the recurrence rate was 2 ± 0.8 % compared to 4.1 ± 0.7 % without NAPCT (criterion T = 2.16, p ˂ 0.05).
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