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Abstract：
The present study aimed to investigate whether local recurrence (LR) after nipple-sparing mastectomy (NSM) and reconstruction was associated with i) Ki67 values and molecular subtypes of the initial lesions, and ii) the size of the initial tumor and the size of the implant. A total of 156 patients with breast cancer with a mean age of 51.58 years (age range, 26-75 years) who underwent NSM with primary implant breast reconstruction were analyzed. After surgery, the mean follow-up time was 59.26 months (range, 17-85 months). Molecular subtypes, Ki67 values, estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) status were recorded for each patient. Additionally, information regarding the size of the implant and the initial tumor size were collected. The information was used to assess LR. For univariate analyses of risk factors, χ2 test, Fisher\'s exact test, Mann-Whitney U test and Student\'s t-test for independent samples were used. For multivariate analyses, a Cox proportional-hazards model was used. NSM was the primary treatment for breast cancer in 34/156 patients (21.8%), while 122/156 (78.2%) of patients received neoadjuvant chemotherapy followed by surgery. Luminal B was the most frequent molecular subtype, detected in 82/156 patients (52.6%), whereas the luminal A subtype was detected in 37 patients (23.7%) and the HER2-enriched subtype was detected in 17/156 patients (10.9%). Ki67 expression was low in 13/156 patients (8.3%), while medium expression was detected in 78/156 patients (50.0%) and high expression was present in 58/156 patients (37.2%). LR was noted in 17/156 patients (10.9%). As determined by univariate analysis, lower ER (P=0.010) and PR (P=0.008) expression were indicated to be significant risk factors for LR. In conclusion, in the present patient cohort, low ER and PR expression were risk factors for LR of breast cancer, whereas Ki67 status and molecular subtype were not statistically significant risk factors for LR. Additionally, the size of the initial tumor and the size of the implant were not risk factors for LR. These findings are consistent with the current literature, and should be utilized when discussing treatment options and potential clinical outcomes with patients prior to surgical management.
摘要：
本研究旨在调查保留乳头乳房切除术（NSM）和重建后的局部复发（LR）是否与i）Ki67值和初始病变的分子亚型有关，和ii)初始肿瘤的大小和植入物的大小。共有156例乳腺癌患者，平均年龄为51.58岁（年龄范围，26-75岁）接受NSM和初次植入乳房重建的患者进行了分析。手术后,平均随访时间为59.26个月(范围，17-85个月）。分子亚型,Ki67值，雌激素受体(ER),记录每位患者的孕激素受体（PR）和人表皮生长因子受体2（HER2）状态。此外,我们收集了有关植入物大小和初始肿瘤大小的信息.该信息用于评估LR。对于风险因素的单变量分析，χ2检验,费希尔的精确检验，对独立样品使用曼-惠特尼U检验和学生t检验。对于多变量分析，使用Cox比例风险模型.NSM是34/156例（21.8%）乳腺癌的主要治疗方法，而122/156（78.2%）的患者接受新辅助化疗，然后手术。管腔B是最常见的分子亚型，在82/156患者中检测到（52.6%），而37例患者(23.7%)检测到管腔A亚型,17/156例患者(10.9%)检测到HER2富集亚型.Ki67在13/156患者中表达较低（8.3%），而在78/156例患者中检测到中等表达(50.0%)，在58/156例患者中检测到高表达(37.2%)。在17/156例患者中发现LR（10.9%）。由单变量分析确定，较低的ER(P=0.010)和PR(P=0.008)表达是LR的显著危险因素.总之,在目前的患者队列中，低ER和PR表达是乳腺癌LR的危险因素，而Ki67状态和分子亚型是LR的无统计学意义的危险因素.此外,初始肿瘤的大小和植入物的大小不是LR的危险因素.这些发现与目前的文献一致，在手术治疗前与患者讨论治疗方案和潜在临床结局时,应加以利用.
