Nipple sparing mastectomy in breast cancer patients and long-term survival outcomes: An analysis of the SEER database

<div><p>Purpose</p><p>To determine the prevalence of nipple-sparing mastectomy (NSM) and its long-term survival outcomes in breast cancer patients.</p><p>Method</p><p>We used the Surveillance, Epidemiology, and End Results database and identified 2,440 breast cancer patients who received NSM during 1998–2013. We used chi-square and binary logistic regression to identify factors associated with the use of radiotherapy after NSM. We used Kaplan-Meier analysis to estimate cancer-specific survival (CSS) and overall survival (OS). We used the log-rank test and Cox regression to identify factors associated with CSS and OS.</p><p>Results</p><p>The median age of the population was 50 years. There were 725 (29.7%), 1064 (43.6%) and 651 (26.7%) patients who had Tis, T1 and T2-3 disease and 1943 (79.6%), 401 (16.4%) and 96 (3.9%) patients who had N0, N1 and N2-3 disease, respectively. The rates of RT use were 61.4%, 39.6% and 10.9% in patients with N2-3 disease, N1 or T3/N0 disease and Tis/T1-2N0 disease, respectively. Elderly age, African American race, and higher T-stage and N-stage were associated with receiving radiotherapy. For patients diagnosed between 1998–2010 (N = 763), the median follow-up was 69 months. The 5- and 10-yr CSS were 96.9% and 94.9%, respectively. The 5- and 10-yr OS were 94.1% and 88.0%, respectively. Ethnicity, T-stage and N-stage were factors independently associated with CSS, and age and T-stage were factors independently associated with OS.</p><p>Conclusions</p><p>The use of NSM has increased, and it is oncologically safe for breast cancer patients.</p></div

Additional file 1: Table S1. of Development of nomograms to predict axillary lymph node status in breast cancer patients

Model performance of the full models and the variants. This table showed the performance of the full models and their variants. (XLSX 42 kb

5-year and 10-year cumulative CSS and OS of patients with different clinicopathological features.

<p>5-year and 10-year cumulative CSS and OS of patients with different clinicopathological features.</p

Temporal trends in the use of RT after NSM by NCCN recommendations.

<p>Temporal trends in the use of RT after NSM by NCCN recommendations.</p

The use of NSM recorded in the SEER database during the study period (1998–2013).

<p>The use of NSM recorded in the SEER database during the study period (1998–2013).</p

Clinicopathologial features of included patients.

<p>Clinicopathologial features of included patients.</p

Independent risk factors for CSS and OS in Cox proportional hazard regression analysis.

<p>Independent risk factors for CSS and OS in Cox proportional hazard regression analysis.</p

Reduced Let-7a Is Associated with Chemoresistance in Primary Breast Cancer.

Chemotherapy resistance remains an important problem in the breast cancer clinic. The ability to predict the patients who would respond to a distinct therapy would help to optimize tailored treatment options. miRNAs can mediate a number of genes in response to drug-induced acute cellular stress. Several studies suggest that let-7 miRNA may be involved in the chemosensitivity of cancer cell lines in vitro. However, it is not known whether this phenomenon occurs in clinical breast tumors. The present study showed that lower let-7a expression was associated with epirubicin resistance in primary breast tumors. Moreover, upregulation of let-7a expression sensitized resistant breast tumor cell lines to epirubicin by enhancing cellular apoptosis in vitro. Collectively, these findings indicate that lower expression of let-7a miRNA can induce chemoresistance in breast cancer by enhancing cellular apoptosis and suggest that let-7a may be used as a therapeutic target to modulate epirubicin-based chemotherapy resistance