Overall Survival, Disease-Free Survival, Local Recurrence, and Nipple–Areolar Recurrence in the Setting of Nipple-Sparing Mastectomy: A Meta-Analysis and Systematic Review
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Nipple-sparing mastectomy (NSM) is an increasingly common procedure; however, concerns exist regarding its oncological safety due to the potential for residual breast tissue to harbor occult malignancy or future cancer.
A systematic literature review was performed. Studies with internal comparison arms evaluating therapeutic NSM versus skin-sparing mastectomy (SSM) and/or modified radical mastectomy (MRM) were included in a meta-analysis of overall survival (OS), disease-free survival (DFS), and local recurrence (LR). Studies lacking comparison arms were only included in the systematic review to evaluate mean OS, DFS, LR, and nipple–areolar recurrence (NAR).
The search yielded 851 articles. Twenty studies with 5594 patients met selection criteria. The meta-analysis included eight studies with comparison arms. Seven studies that compared OS found a 3.4 % risk difference between NSM and MRM/SSM, five studies that compared DFS found a 9.6 % risk difference between NSM and MRM/SSM, and eight studies that compared LR found a 0.4 % risk difference between NSM and MRM/SSM. Risk differences for all outcomes were not statistically significant. The systematic review included all 20 studies and evaluated OS, DFS, LR, and NAR. Studies with follow-up intervals of <3 years, 3–5 years, and >5 years had mean OS of 97.2, 97.9, and 86.8 %; DFS of 93.1, 92.3, and 76.1 %; LR of 5.4, 1.4, and 11.4 %; and NAR of 2.1, 1.0, and 3.4 %, respectively.
This study did not detect adverse oncologic outcomes of NSM in carefully selected women with early-stage breast cancer. Use of prospective data registries, notably the Nipple-Sparing Mastectomy Registry, will add clarity to this important clinical question.
KeywordsOverall Survival Local Recurrence Invasive Ductal Carcinoma Nipple Risk Difference
This manuscript includes preliminary data presented at the 16th Annual Meeting of the American Society of Breast Surgeons, and incorporates additional analyses that have undergone peer review. The authors would like to thank Dr. Beth-Ann Lesnikoski for reviewing our initial abstract presented at the meeting.
Lucy De La Cruz conceptualized and designed the project. Eric Hecht, Stephanie Blankenship, Alison Moody, and Erryn Tappy drafted the initial manuscript. All authors reviewed, revised, and approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
No external funding was secured for this study. Lucy De La Cruz, Alison M. Moody, Erryn E. Tappy, Stephanie A. Blankenship, and Eric M. Hecht have no financial relationships or conflicts of interest to disclose that are relevant to this article.
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