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01-12-2021 | Mastectomy | Breast Oncology

Immediate Breast Reconstruction for Inflammatory Breast Cancer: Trends in Use and Clinical Outcomes 2004–2016

Authors: Daniel I. Hoffman, MD, Patricia Mae G. Santos, MD, MS, Macy Goldbach, BS, Luke J. Keele, PhD, Neil K. Taunk, MD, MS, Hannah S. Bogen, MD, Laura Burkbauer, MD, Rachel C. Jankowitz, MD, Joshua Fosnot, MD, Liza C. Wu, MD, Gary M. Freedman, MD, Julia C. Tchou, MD, PhD

Published in: Annals of Surgical Oncology | Issue 13/2021

Abstract

Introduction

National guidelines specify against immediate breast reconstruction (IBR) among inflammatory breast cancer (IBC) patients. However, limited data exist regarding this practice. We report practice patterns and oncologic outcomes among nonmetastatic IBC patients receiving trimodality therapy, with or without IBR.

Methods

Using the National Cancer Database, we identified nonmetastatic IBC patients treated with trimodality therapy from 2004 to 2016. Primary outcome was overall survival (OS), assessed on unadjusted analysis using Kaplan–Meier estimates and on adjusted analysis using multivariable Cox proportional hazards and inverse probability weighting (IPW) models. OS analysis was also conducted with propensity score matched (PSM) cohorts. Secondary outcomes included IBR utilization rates, time to postmastectomy radiotherapy (PMRT), and surgical outcomes.

Results

6589 women were included, including 5954 (90.4%) non-reconstructed and 635 (9.6%) IBR. Among IBR recipients, 250 (39.4%) underwent autologous reconstruction, 171 (26.9%) underwent implant-based reconstruction, and 214 (33.7%) unspecified. IBR utilization increased from 6.3% to 10.1% from 2004 to 2016 at a 4% average annual growth rate (P < 0.001). Median follow-up was 43 and 45 months for IBR and non-reconstructed patients, respectively (P = 0.29). On Cox multivariable analysis, IBR was associated with improved OS (HR 0.63, 95% CI 0.44–0.90, P = 0.01), but this association was not significant on IPW analysis (P = 0.06). In PSM cohorts, this association remained significant (HR 0.60, 95% CI 0.40–0.92, P = 0.02). Margin status, time to PMRT, 30-day readmission, and 30-/90-day mortality did not differ between groups (all P > 0.05).

Conclusion

Although not endorsed by national guidelines, IBR is increasing among IBC patients; however, more granular data are needed to determine oncologic safety.

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Title: Immediate Breast Reconstruction for Inflammatory Breast Cancer: Trends in Use and Clinical Outcomes 2004–2016
Authors: Daniel I. Hoffman, MD
Patricia Mae G. Santos, MD, MS
Macy Goldbach, BS
Luke J. Keele, PhD
Neil K. Taunk, MD, MS
Hannah S. Bogen, MD
Laura Burkbauer, MD
Rachel C. Jankowitz, MD
Joshua Fosnot, MD
Liza C. Wu, MD
Gary M. Freedman, MD
Julia C. Tchou, MD, PhD
Publication date: 01-12-2021
Publisher: Springer International Publishing
Keywords: Mastectomy
Breast Cancer
Breast Cancer
Published in: Annals of Surgical Oncology / Issue 13/2021
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-021-10404-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Immediate Breast Reconstruction for Inflammatory Breast Cancer: Trends in Use and Clinical Outcomes 2004–2016

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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