Oncologic Outcomes After Neoadjuvant Chemotherapy and Postmastectomy Breast Reconstruction
Menée en Corée du Sud à partir de données portant sur 1 266 patientes atteintes d'un cancer du sein traité par chimiothérapie néoadjuvante et mastectomie avec ou sans reconstruction mammaire entre 2010 et 2016 (durée médiane de suivi : 67 ou 68 mois selon le groupe de patients), cette étude évalue l'équivalence, du point de vue des taux de survie à 5 ans, d'une reconstruction mammaire immédiate avec mastectomie épargnant le mamelon ou la peau et d'une mastectomie conventionnelle
For women with breast cancer, rates of locoregional recurrence after skin- and nipple-sparing mastectomy are low (approximately 5%) and often exceeded by those for distant metastases. As a result, these contemporary mastectomy techniques in conjunction with breast reconstruction have become widely adopted owing to improved patient-reported outcomes related to cosmesis and quality of life.The NSABP B-18 and NSABP B-27 clinical trials ushered in a different but equally important paradigm shift in the treatment of breast cancer by demonstrating the safety and efficacy of preoperative systemic therapy. Response to neoadjuvant chemotherapy (NACT) has emerged as an important prognosticator and factor in adjuvant-treatment decisions. Pathologic complete response is associated with survival and may facilitate eligibility for breast conservation and obviate the need for axillary lymphadenectomy. But more recently, receipt of NACT has been paradoxically associated with more extensive surgery, specifically higher rates of bilateral mastectomy and postmastectomy reconstruction in women who might otherwise have been candidates for lumpectomy.
JAMA Surgery , éditorial, 2019