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Immediate breast reconstruction has no impact on the oncologic outcomes of patients treated with post-mastectomy radiation therapy: a comparative analysis based on propensity score matching

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Abstract

Purpose

To investigate the impact of immediate breast reconstruction (iBR) on patients treated with post-mastectomy radiation therapy (PMRT) using propensity score matching (PSM).

Methods

After a retrospective review of patients treated with PMRT between 2008 and 2017, we included 153 patients who underwent iBR and 872 patients who did not undergo iBR. Among the 153 patients who underwent iBR, 34 received one-stage iBR with autologous tissue and 119 received two-stage iBR. Conventional fractionated PMRT with a total dose of 50–50.4 Gy in 25–28 fractions was performed in all patients. Propensity scores were calculated via logistic regression.

Results

Patients who underwent iBR were younger, had early stage disease, and had more frequent hormone receptor-positive tumor than those who did not undergo iBR. After PSM, 127 patients from each group with well-balanced characteristics were selected. With a median follow-up of 67.5 months, iBR led to better 6-year disease-free survival rates compared to no iBR before PSM (84.8% vs. 71.4%, p = 0.003); after PSM, there was no significant difference (84.8% vs. 75.5%, p = 0.130). On multivariable analysis in the matched cohort, iBR was not associated with inferior disease-free survival (hazard ratio, 0.67; p = 0.175). In the sensitivity analysis, iBR was not associated with a lower disease-free survival across all prognostic groups. The 5-year cumulative incidence of iBR failure was 15.0%.

Conclusion

In patients with adverse pathologic factors planning to receive PMRT, iBR did not compromise oncologic outcomes. In addition, iBR can be considered in patients treated with PMRT with several clinicopathologic risk factors.

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Availability of data and material

It is limited due to institutional data protection law and confidentiality of patient data.

Code availability

No code was used for this study.

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Acknowledgements

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Funding

This research was supported by a grant funded by the Ministry of Science and ICT, Republic of Korea (NRF-2019R1F1A1062069).

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Authors and Affiliations

  1. Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea

    Nalee Kim, Haeyoung Kim, Won Park, Doo Ho Choi & Won Kyung Cho

  2. Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Seok Jin Nam, Jeong Eon Lee, Seok Won Kim, Jonghan Yu & Sei Kyung Lee

  3. Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Byung-Joon Jeon, Jai Kyong Pyon & Goo-Hyun Mun

  4. Department of Radiation Oncology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Tae Gyu Kim

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  1. Nalee Kim
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Correspondence to Haeyoung Kim.

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This study was approved by the Institutional Review Board of Samsung Medical Center (No. 2020-10-175).

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Kim, N., Kim, H., Park, W. et al. Immediate breast reconstruction has no impact on the oncologic outcomes of patients treated with post-mastectomy radiation therapy: a comparative analysis based on propensity score matching. Breast Cancer Res Treat 192, 101–112 (2022). https://doi.org/10.1007/s10549-021-06483-2

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