Long-Term Safety of Level II Oncoplastic Surgery after Neoadjuvant Treatment for Locally Advanced Breast Cancer: A 20-Year Experience
Abstract
:1. Introduction
2. Materials and Methods
2.1. Clinical Workout
- Patients with LABC;
- Patients with operable breast cancer and an unfavorable breast volume/tumor size ratio in order to reduce the tumor diameter and achieve a conservative treatment instead of mastectomy;
- Patients with operable breast cancer and clinically involved lymph nodes (cN+) to ensure a sentinel lymph node biopsy (SLNB) instead of a direct axillary lymph node dissection (ALND);
- Young patients with unfavorable risk factors (Triple negative tumor, HER2+, high Ki-67 rates) to provide prompt systemic treatment.
2.1.1. Pre-Neoadjuvant Clinical Staging
2.1.2. Neoadjuvant Regimens
- Sequential taxane and anthracycline-containing regimen: Anthracyclines plus Cyclophosphamide on day 1 every 21 days for 4 cycles (4 AC), followed by docetaxel on day 1 every 21 days for 4 cycles or paclitaxel on day 1 every week for 12 cycles;
- TAC: Docetaxel plus Doxorubicin plus Cyclophosphamide on day 1 every 21 days for 6 cycles.
- TCH: Docetaxel plus Carboplatin plus Herceptin on day 1 every 21 days for 6 cycles;
- Sequential regimen taxane and anthracycline-containing regimen + H: Anthracyclines plus Cyclophosphamide on day 1 every 21 days for 4 cycles (4 AC), followed by docetaxel on day 1 every 21 days for 4 cycles or paclitaxel on day 1 every week for 12 cycles plus Herceptin on day 1 every 21 days for 18 cycles;
- Hormone therapy: Aromatase inhibitor delivered in elder and fragile postmenopausal patients with locally advanced breast cancer expressing hormone receptors (ER, PgR) and low Ki-67 (Luminal A and Luminal B); neoadjuvant protocol administered for at least six months.
2.1.3. Clinical Assessments during and after NACT
2.1.4. Breast Surgical Treatment
2.1.5. Axillary Assessment
2.1.6. Adjuvant Treatment
2.1.7. Adjuvant Chemotherapy
- Antracyclines and/or taxanes were given to patients who did not receive them in the neoadjuvant regimen;
- Triple-negative patients were given Capecitabine;
- HER2-positive cancers were treated with TDM-1;
- Cancers expressing hormone receptors (ER, PgR) were treated with selective estrogen receptor modulators (Tamoxifen) + or − LHRH analogues (Enantone, Decapeptyl) if in premenopausal age. Postmenopausal patients were given aromatase inhibitors (Anastrozole, Letrozole, Exemestane).
2.1.8. Adjuvant Radiotherapy
2.1.9. Exclusion Criteria
- Patients with cN2 stage or more at diagnosis;
- Persistence of clinical axillary nodal metastasis at post-NACT restaging:
- Patients that presented with LABC intended as cT4 tumor;
- Metastatic patients (excluding axillary lymph nodes involvement);
- Patients treated for breast recurrent malignancy/second breast tumors;
- Patients with persistence of multifocal/multicentric disease after NACT (not intended as fragmentation of the initial lesion).
2.2. Endpoints and Purpose of Our Study
2.2.1. Surgical Endpoints
- Estimates of OPS effectiveness indicators were measured during surgical procedure, intended as mean specimen volume;
- Positive Margin Rate (PMR) was defined, for invasive carcinomas, as the presence of tumor on ink, in accordance with the ASCO guidelines [23]. For cases treated until 2015 for ductal carcinomas in situ (DCIS), an involved margin was defined as tumor on ink. From 2015, an involved margin is defined as a distance lower than 2 mm between the tumor foci and the inked margin, as assessed by the European Society for Medical Oncology (ESMO) [4], and National Comprehensive Cancer Network (NCCN) guidelines [1];
- Re-excision Rate (RR) was percentage of patients undergoing surgical enlargement of margins following proven margin involvement at pathology report;
- Conversion to Mastectomy Rate (CMR) was percentage of patients who required mastectomy as the only treatment possible to obtain a margin widening following margin involvement at pathology report;
- Complications Rate (CR) was percentage of complications related to surgical treatment that occurred during the postoperative period (within 30 days from surgical procedure), including seroma, liponecrosis, hematomas, surgical site infections (including clinical signs and microbiological evidence), and wound dehiscence that required surgical reintervention.
2.2.2. Oncological Endpoints
- Overall Survival (OS): calculated as the difference between the time of surgery and the date of death or censored at the date of last follow-up;
- Disease-Free Survival (DFS): calculated as the difference between the time between the time of surgery and the date of relapse (locoregional or distant) or censored at the time of last evaluation;
- Local Recurrence (LR): Number of patients who developed an ipsilateral locoregional recurrence of disease (chest wall, residual gland, skin, and axillary lymph nodes) following surgical treatment out of the total number of patients included in this study.
2.3. Statistical Analysis
3. Results
3.1. Pathological Features
3.2. NACT Regimes
3.3. Clinical Restaging after NACT
3.4. Breast Surgery
3.5. Pathological Response to NACT
- Response on T: We observed a complete pathological response (ypT0) in 12 patients (11%), and in 5 cases (4%), we detected residual intraductal carcinoma (ypTis). Sixty-two patients (56%) had residual ypT1 tumor, and twenty-nine (26%) were ypT2, while only three patients (3%) were ypT3;
- Response on N: Among the 111 patients, 44 (40%) that were N+ at the time of diagnosis were proven ypN0 after NACT (12/111);
- Pathological complete response: Among patients proven node positive at the time of diagnosis, we observed a complete patholocal response even on T and on N in 13 (11.7%) and an ypTis, ypN0 condition in 6 patients (5.4%).
3.6. Surgical Outcomes
3.7. Adjuvant Treatments
3.8. Oncologic Outcomes
3.9. Matched Cohort Analysis
4. Discussion
5. Conclusions
- Level II OPS can be considered a reliable alternative to breast conserving surgery or demolitive procedures, such as conservative mastectomies, in cases with a glandular demolition range of 20–30% of the overall glandular volume, even in the post-NACT setting. Our surgical and oncological outcomes strengthen the reported data, mostly based on lower sample sizes and a shorter follow-up period;
- Breast surgeons must be fully trained in level II OPS, and these techniques have to be more frequently offered to patients who benefit from a NACT response in the conviction that this treatment is not only reliable, but it also can grant a more natural result;
- Our study analyzed 20 years of surgical activity in a high-volume breast unit, where the treatments offered have always been the result of multidisciplinary diagnostic and therapeutic protocols, especially in the post-NACT setting. The implementation of level II OPS techniques in such a delicate scenario can only take place in highly trained centers.
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Gradishar, W.J.; Moran, M.S.; Abraham, J.; Aft, R.; Agnese, D.; Allison, K.H.; Anderson, B.; Burstein, H.J.; Chew, H.; Dang, C.; et al. Breast Cancer, Version 3.2022, NCCN Clinical Practice Guidelines in Oncology. J. Natl. Compr. Cancer Netw. 2022, 20, 691–722. [Google Scholar] [CrossRef] [PubMed]
- Allemani, C.; Sant, M.; Weir, H.K.; Richardson, L.C.; Baili, P.; Storm, H.; Siesling, S.; Torrella-Ramos, A.; Voogd, A.C.; Aareleid, T.; et al. Breast cancer survival in the US and Europe: A CONCORD high-resolution study. Int. J. Cancer 2013, 132, 1170–1181. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- Brinton, L.A.; Figueroa, J.D.; Awuah, B.; Yarney, J.; Wiafe, S.; Wood, S.N.; Ansong, D.; Nyarko, K.; Wiafe-Addai, B.; Clegg-Lamptey, J.N. Breast cancer in Sub-Saharan Africa: Opportunities for prevention. Breast Cancer Res. Treat. 2014, 144, 467–478. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- Loibl, S.; André, F.; Bachelot, T.; Barrios, C.H.; Bergh, J.; Burstein, H.J.; Cardoso, M.J.; Carey, L.A.; Dawood, S.; Del Mastro, L.; et al. Electronic address: [email protected]. Early breast cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol. 2024, 35, 159–182. [Google Scholar] [CrossRef] [PubMed]
- Linee Guida Neoplasie Della Mammella. AIOM. Published. 18 November 2021. Available online: https://www.aiom.it/linee-guida-aiom-2021-neoplasie-della-mammella/ (accessed on 9 June 2023).
- Kaufmann, M.; Morrow, M.; von Minckwitz, G.; Harris, J.R.; Biedenkopf Expert Panel Members. Locoregional treatment of primary breast cancer: Consensus recommendations from an International Expert Panel. Cancer 2010, 116, 1184–1191. [Google Scholar] [CrossRef] [PubMed]
- Clough, K.B.; Kaufman, G.J.; Nos, C.; Buccimazza, I.; Sarfati, I.M. Improving breast cancer surgery: A classification and quadrant per quadrant atlas for oncoplastic surgery. Ann. Surg. Oncol. 2010, 17, 1375–1391. [Google Scholar] [CrossRef] [PubMed]
- von Minckwitz, G. Neoadjuvant chemotherapy in breast cancer-insights from the German experience. Breast Cancer 2012, 19, 282–288. [Google Scholar] [CrossRef] [PubMed]
- Huober, J.; von Minckwitz, G. Neoadjuvant Therapy—What Have We Achieved in the Last 20 Years? Breast Care 2011, 6, 419–426. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- von Minckwitz, G.; Rezai, M.; Loibl, S.; Fasching, P.A.; Huober, J.; Tesch, H.; Bauerfeind, I.; Hilfrich, J.; Eidtmann, H.; Gerber, B.; et al. Capecitabine in addition to anthracycline- and taxane-based neoadjuvant treatment in patients with primary breast cancer: Phase III GeparQuattro study. J. Clin. Oncol. 2010, 28, 2015–2023. [Google Scholar] [CrossRef] [PubMed]
- Barranger, E.; Antomarchi, J.; Chamorey, E.; Cavrot, C.; Flipo, B.; Follana, P.; Peyrottes, I.; Chapellier, C.; Ferrero, J.M.; Ihrai, T. Effect of Neoadjuvant Chemotherapy on the Surgical Treatment of Patients with Locally Advanced Breast Cancer Requiring Initial Mastectomy. Clin. Breast Cancer 2015, 15, e231–e235. [Google Scholar] [CrossRef] [PubMed]
- Sanchez, A.M.; Franceschini, G.; D’Archi, S.; De Lauretis, F.; Scardina, L.; Di Giorgio, D.; Accetta, C.; Masetti, R. Results obtained with level II oncoplastic surgery spanning 20 years of breast cancer treatment: Do we really need further demonstration of reliability? Breast J. 2020, 26, 125–132. [Google Scholar] [CrossRef] [PubMed]
- Garcia-Etienne, C.A.; Tomatis, M.; Heil, J.; Friedrichs, K.; Kreienberg, R.; Denk, A.; Kiechle, M.; Lorenz-Salehi, F.; Kimmig, R.; Emons, G.; et al. Mastectomy trends for early-stage breast cancer: A report from the EUSOMA multi-institutional European database. Eur. J. Cancer 2012, 48, 1947–1956. [Google Scholar] [CrossRef] [PubMed]
- Clough, K.B.; Acosta-Marín, V.; Nos, C.; Alran, S.; Rouanet, P.; Garbay, J.R.; Giard, S.; Verhaeghe, J.L.; Houvenaeghel, G.; Flipo, B.; et al. Rates of Neoadjuvant Chemotherapy and Oncoplastic Surgery for Breast Cancer Surgery: A French National Survey. Ann. Surg. Oncol. 2015, 22, 3504–3511. [Google Scholar] [CrossRef] [PubMed]
- Habermann, E.B.; Abbott, A.; Parsons, H.M.; Virnig, B.A.; Al-Refaie, W.B.; Tuttle, T.M. Are mastectomy rates really increasing in the United States? J. Clin. Oncol. 2010, 28, 3437–3441. [Google Scholar] [CrossRef] [PubMed]
- Mahmood, U.; Hanlon, A.L.; Koshy, M.; Buras, R.; Chumsri, S.; Tkaczuk, K.H.; Cheston, S.B.; Regine, W.F.; Feigenberg, S.J. Increasing national mastectomy rates for the treatment of early stage breast cancer. Ann. Surg. Oncol. 2013, 20, 1436–1443. [Google Scholar] [CrossRef] [PubMed]
- McLaughlin, S.A. Surgical management of the breast: Breast conservation therapy and mastectomy. Surg. Clin. N. Am. 2013, 93, 411–428. [Google Scholar] [CrossRef] [PubMed]
- Marinovich, M.L.; Houssami, N.; Macaskill, P.; Sardanelli, F.; Irwig, L.; Mamounas, E.P.; von Minckwitz, G.; Brennan, M.E.; Ciatto, S. Meta-analysis of magnetic resonance imaging in detecting residual breast cancer after neoadjuvant therapy. J. Natl. Cancer Inst. 2013, 105, 321–333. [Google Scholar] [CrossRef] [PubMed]
- Masetti, R.; Di Leone, A.; Franceschini, G.; Magno, S.; Terribile, D.; Fabbri, M.C.; Chiesa, F. Oncoplastic techniques in the conservative surgical treatment of breast cancer: An overview. Breast J. 2006, 12 (Suppl. S2), S174–S180. [Google Scholar] [CrossRef] [PubMed]
- Masetti, R.; Pirulli, P.G.; Magno, S.; Franceschini, G.; Chiesa, F.; Antinori, A. Oncoplastic techniques in the conservative surgical treatment of breast cancer. Breast Cancer 2000, 7, 276–280. [Google Scholar] [CrossRef] [PubMed]
- Anderson, B.O.; Masetti, R.; Silverstein, M.J. Oncoplastic approaches to partial mastectomy: An overview of volume-displacement techniques. Lancet Oncol. 2005, 6, 145–157. [Google Scholar] [CrossRef] [PubMed]
- Sanchez, A.M.; Terribile, D.; Franco, A.; Martullo, A.; Orlandi, A.; Magno, S.; Di Leone, A.; Moschella, F.; Natale, M.; D’Archi, S.; et al. Sentinel Node Biopsy after Neoadjuvant Chemotherapy for Breast Cancer: Preliminary Experience with Clinically Node Negative Patients after Systemic Treatment. J. Pers. Med. 2021, 11, 172. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- Breast Cancer. ASCO. Available online: https://old-prod.asco.org/practice-patients/guidelines/breast-cancer (accessed on 14 June 2023).
- Diao, K.; Lei, X.; He, W.; Jagsi, R.; Giordano, S.H.; Smith, G.L.; Caudle, A.; Shen, Y.; Peterson, S.K.; Smith, B.D. Patient-reported Quality of Life After Breast-conserving Surgery With Radiotherapy Versus Mastectomy and Reconstruction. Ann. Surg. 2023, 278, e1096–e1102. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- Losken, A.; Pinell-White, X.; Hart, A.M.; Freitas, A.M.; Carlson, G.W.; Styblo, T.M. The oncoplastic reduction approach to breast conservation therapy: Benefits for margin control. Aesthet. Surg. J. 2014, 34, 1185–1191. [Google Scholar] [CrossRef] [PubMed]
- De La Cruz, L.; Blankenship, S.A.; Chatterjee, A.; Geha, R.; Nocera, N.; Czerniecki, B.J.; Tchou, J.; Fisher, C.S. Outcomes After Oncoplastic Breast-Conserving Surgery in Breast Cancer Patients: A Systematic Literature Review. Ann. Surg. Oncol. 2016, 23, 3247–3258. [Google Scholar] [CrossRef] [PubMed]
- Kunnuru, S.K.R.; Thiyagarajan, M.; Martin Daniel, J.; Singh, K.B. A Study on Clinical and Pathological Responses to Neoadjuvant Chemotherapy in Breast Carcinoma. Breast Cancer Targets Ther. 2020, 12, 259–266. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: Meta-analysis of individual patient data from ten randomised trials. Lancet Oncol. 2018, 19, 27–39. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- Mazouni, C.; Naveau, A.; Kane, A.; Dunant, A.; Garbay, J.R.; Leymarie, N.; Sarfati, B.; Delaloge, S.; Rimareix, F. The role of oncoplastic breast surgery in the management of breast cancer treated with primary chemotherapy. Breast 2013, 22, 1189–1193. [Google Scholar] [CrossRef] [PubMed]
- Franceschini, G.; Mason, E.J.; Grippo, C.; D’Archi, S.; D’Angelo, A.; Scardina, L.; Sanchez, A.M.; Conti, M.; Trombadori, C.; Terribile, D.A.; et al. Image-Guided Localization Techniques for Surgical Excision of Non-Palpable Breast Lesions: An Overview of Current Literature and Our Experience with Preoperative Skin Tattoo. J. Pers. Med. 2021, 11, 99. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- Gulcelik, M.A.; Dogan, L. Feasibility of level II oncoplastic techniques in the surgical management of locally advanced breast cancer after neoadjuvant treatment. Int. J. Clin. Pract. 2021, 75, e13987. [Google Scholar] [CrossRef] [PubMed]
- Emiroglu, M.; Sert, I.; Karaali, C.; Aksoy, S.O.; Ugurlu, L.; Aydın, C. The effectiveness of simultaneous oncoplastic breast surgery in patients with locally advanced breast cancer. Breast Cancer 2016, 23, 463–470. [Google Scholar] [CrossRef] [PubMed]
- Adamson, K.; Chavez-MacGregor, M.; Caudle, A.; Smith, B.; Baumann, D.; Liu, J.; Schaverien, M. Neoadjuvant Chemotherapy does not Increase Complications in Oncoplastic Breast-Conserving Surgery. Ann. Surg. Oncol. 2019, 26, 2730–2737. [Google Scholar] [CrossRef] [PubMed]
- Vieira, R.A.; Carrara, G.F.; Scapulatempo Neto, C.; Morini, M.A.; Brentani, M.M.; Folgueira, M.A. The role of oncoplastic breast conserving treatment for locally advanced breast tumors. A matching case-control study. Ann. Med. Surg. 2016, 10, 61–68. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- van la Parra, R.F.D.; Clough, K.B.; Thygesen, H.H.; Levy, E.; Poulet, B.; Sarfati, I.; Nos, C. Oncological Safety of Oncoplastic Level II Mammoplasties After Neoadjuvant Chemotherapy for Large Breast Cancers: A Matched-Cohort Analysis. Ann. Surg. Oncol. 2021, 28, 5920–5928. [Google Scholar] [CrossRef] [PubMed]
Entire NACT Cohort (111 Patients) | Post-NACT Matched Cohort (44 Patients) | Non-NACT Matched Cohort (44 Patients) | p-Value | |
---|---|---|---|---|
Mean age | 47.68 (26–70) | 46.53 (30–65) | 47.46 (24–72) | 0.50 |
Histology | 0.45 | |||
Ductal | 84 (76%) | 34 (77%) | 33 (75%) | |
Lobular | 16 (14%) | 8 (18%) | 6 (14%) | |
Other Categories | 11 (10%) | 2 (5%) | 5 (11%) | |
Grading | 0.30 | |||
1 | 2 (2%) | 2 (5%) | 7 (16%) | |
2 | 79 (71%) | 26 (59%) | 26 (59%) | |
3 | 30 (27%) | 16 (36%) | 11 (25%) | |
Luminal Type | 0.31 | |||
Luminal A | 25 (23%) | 10 (23%) | 10 (23%) | |
Luminal B | 37 (33%) | 12 (27%) | 7 (16%) | |
HER2+ luminal | 15 (13.5%) | 7 (16%) | 15 (34%) | |
HER2+ non luminal | 16 (14.5%) | 5 (11%) | 5 (11%) | |
Triple-negative | 18 (16%) | 10 (23%) | 7 (16%) | |
cT stage | 0.35 | |||
1 | 23 (21%) | 10 (23%) | 5 (11%) | |
2 | 72 (65%) | 28 (64%) | 33 (75%) | |
3 | 16 (14%) | 6 (13%) | 6 (14%) | |
cN stage | 0.49 | |||
0 | 67 (60%) | 29 (66%) | 32 (73%) | |
1 | 44 (40%) | 15 (34%) | 12 (27%) | |
NACT regimens | ||||
Sequential | 48 (43%) | 23 (52%) | - | |
Herceptin containing regimen | 25 (22%) | 1 (2%) | - | |
TAC | 13 (12%) | 3 (7%) | - | |
Others | 25 (23%) | 17 (39%) | - | |
Clinical Response on T | ||||
Complete | 21 (19%) | 10 (23%) | - | |
Partial | 78 (70%) | 30 (68%) | - | |
No response | 12 (11%) | 4 (9%) | - | |
Upper quadrants | 68 (61%) | 22 (50%) | 26 (59%) | |
Inverted T mammoplasty with inferior pedicle | 30 (44%) | 12 (55%) | 15 (58%) | |
J- reduction mammoplasty | 31 (46%) | 9 (41%) | 8 (31%) | |
Round block technique | 7 (10%) | 1 (4%) | 3 (11%) | |
Central quadrants | 11 (10%) | 5 (11%) | - | |
J-reduction mammoplasty | 4 (36%) | 1 (20%) | - | |
Round block | 3 (28%) | 2 (40%) | - | |
Grisotti | 4 (36%) | 2 (40%) | - | |
Lower quadrants | 15 (14%) | 7 (16%) | 11 (25%) | |
Inverted T mammoplasty with superior pedicle | 8 (53%) | 4 (57%) | 6 (55%) | |
J-reduction mammoplasty | 7 (47%) | 3 (43%) | 4 (36%) | |
Round block technique | - | - | 1 (9%) | |
Multicentric tumors | 17 (15%) | 10 (23%) | 7 (16%) | |
Inverted T mammoplasty with inferior pedicle | 3 (18%) | 1 (10%) | 4 (57%) | |
Inverted T mammoplasty with upper pedicle | 1 (6%) | - | 3 (43%) | |
J-reduction mammoplasty | 10 (58%) | 8 (80%) | - | |
Round block technique | 1 (6%) | 1 (10%) | - | |
Grisotti technique | 2 (12%) | - | - | |
Mean specimen volume (mm3) | 390,796 (27,000–3,700,000) | 353,439 (27,000–2,646,000) | 209,921 (217–1,275,000) | 0.042 |
ypT | 0.001 | |||
0 | 12 (11%) | 5 (11%) | - | |
Is | 5 (4%) | 1 (2%) | 2 (5%) | |
1 | 62 (56%) | 25 (57%) | 13 (29%) | |
2 | 29 (26%) | 12 (28%) | 27 (61%) | |
3 | 3 (3%) | 1 (2%) | 2 (5%) | |
ypN | 0.42 | |||
0 | 36 (32%) | 22 (50%) | 21 (47%) | |
1 | 48 (43%) | 15 (34%) | 19 (43%) | |
2 | 24 (22%) | 6 (14%) | 2 (5%) | |
3 | 3 (3%) | 1 (2%) | 2 (5%) | |
Complications Rate | 6 (5%) | 2 (5%) | 3 (7%) | 1.000 |
Wound dehiscence | 2 (33%) | 1 (50%) | 1 (33%) | |
Seroma | 3 (50%) | 1 (50%) | 1 (33%) | |
Infection | 1 (17%) | - | - | |
Hematoma | - | - | 1 (33%) | |
Skin necrosis | - | - | - | |
Positive Margin Rate | 4 (3.6%) | - | 7 (16%) | 0.012 |
Re-excision Rate | 2 (50%) | - | 4 (57%) | |
Conversion to mastectomy rate | 1 (25%) | - | - | |
Boost | 1 (25%) | - | 3 (43) | |
Adjuvant therapy | ||||
Hormone therapy | 72 (65%) | 29 (66%) | 26 (59%) | 0.660 |
RT | 110 (99%) | 44 (100%) | 44 (100%) | 1.000 |
10-year Overall survival | 79% | 89% | 95% | 0.207 |
10-year Disease-Free Survival | 76% | 84% | 69% | 0.106 |
10-year Local recurrence | 5% | 5% | 18% | 0.140 |
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Sanchez, A.M.; De Lauretis, F.; Bucaro, A.; Borghesan, N.; Pirrottina, C.V.; Franco, A.; Scardina, L.; Giannarelli, D.; Millochau, J.C.; Parapini, M.L.; et al. Long-Term Safety of Level II Oncoplastic Surgery after Neoadjuvant Treatment for Locally Advanced Breast Cancer: A 20-Year Experience. J. Clin. Med. 2024, 13, 3665. https://doi.org/10.3390/jcm13133665
Sanchez AM, De Lauretis F, Bucaro A, Borghesan N, Pirrottina CV, Franco A, Scardina L, Giannarelli D, Millochau JC, Parapini ML, et al. Long-Term Safety of Level II Oncoplastic Surgery after Neoadjuvant Treatment for Locally Advanced Breast Cancer: A 20-Year Experience. Journal of Clinical Medicine. 2024; 13(13):3665. https://doi.org/10.3390/jcm13133665
Chicago/Turabian StyleSanchez, Alejandro M., Flavia De Lauretis, Angela Bucaro, Niccolo Borghesan, Chiara V. Pirrottina, Antonio Franco, Lorenzo Scardina, Diana Giannarelli, Jenny C. Millochau, Marina L. Parapini, and et al. 2024. "Long-Term Safety of Level II Oncoplastic Surgery after Neoadjuvant Treatment for Locally Advanced Breast Cancer: A 20-Year Experience" Journal of Clinical Medicine 13, no. 13: 3665. https://doi.org/10.3390/jcm13133665