Breast cancer research and treatment · 2025
Impact of lymph node status on the prognosis of female breast cancer patients who underwent immediate reconstruction after total mastectomy: a multi-institutional retrospective cohort study.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Xu Qianrui, Li Xinyan, Deng Xiehui, Li Miaosi, Zong Xiangyun
Аннотация
PURPOSE: This study aims to evaluate the impact of lymph node status on survival outcomes in female breast cancer patients underwent immediate breast reconstruction (IBR) after mastectomy.
METHODS: Data from 8418 cases (2010-2017) receiving IBR were divided into regional lymph node negative (LN-) and positive (LN+) groups. Propensity score matching (PSM) was used to balance covariates between groups. Subgroup Cox regression analysis was performed to assess overall survival (OS) and breast cancer-specific survival (BCSS), considering sociodemographic, oncological, and treatment-related factors.
RESULTS: Inpatients underwent IBR, the LN+ group exhibited significantly poorer OS and BCSS than the LN- group, both before and after PSM. Higher income, specific tumor characteristics, and implant-based reconstruction were related to better survival outcomes. Subgroup analysis revealed that in LN- group, lower income, HR-, HER2- status, and higher tumor grade were OS/BCSS risk factors. In the LN+ group, advanced T stage independently predicted worse OS/BCSS, and contralateral breast removal was associated with a decrease in OS risk.
CONCLUSIONS: Caution is warranted when recommending IBR for patients with N2-3, and implant-based reconstruction may represent a more favorable option in selected cases. LN+ status is a significant adverse prognostic factor in IBR patients. Personalized treatment strategies based on LN status are essential for optimizing survival outcomes.
METHODS: Data from 8418 cases (2010-2017) receiving IBR were divided into regional lymph node negative (LN-) and positive (LN+) groups. Propensity score matching (PSM) was used to balance covariates between groups. Subgroup Cox regression analysis was performed to assess overall survival (OS) and breast cancer-specific survival (BCSS), considering sociodemographic, oncological, and treatment-related factors.
RESULTS: Inpatients underwent IBR, the LN+ group exhibited significantly poorer OS and BCSS than the LN- group, both before and after PSM. Higher income, specific tumor characteristics, and implant-based reconstruction were related to better survival outcomes. Subgroup analysis revealed that in LN- group, lower income, HR-, HER2- status, and higher tumor grade were OS/BCSS risk factors. In the LN+ group, advanced T stage independently predicted worse OS/BCSS, and contralateral breast removal was associated with a decrease in OS risk.
CONCLUSIONS: Caution is warranted when recommending IBR for patients with N2-3, and implant-based reconstruction may represent a more favorable option in selected cases. LN+ status is a significant adverse prognostic factor in IBR patients. Personalized treatment strategies based on LN status are essential for optimizing survival outcomes.