787892 - Contralateral Prophylactic Mastectomy Trends and Outcomes for Non-metastatic Inflammatory Breast Cancer: Stage-stratified Propensity Scoring Analysis of NCDB

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Annals of Surgical Oncology


Background/Objective: A limited number of studies looked into performing contralateral prophylactic mastectomies (CPM) for non-metastatic inflammatory breast cancer (IBC). The purpose of this study is to examine the trends and survival outcomes of performing CPM in IBC patients using the National Cancer Database (NCDB). Methods: NCDB data from 2004 to 2014 were retrospectively analyzed. Patients’ demographics, tumor characteristics, and survival trends and outcomes were compared between Stages I-III IBC patients who underwent a CPM and those who did not (no-CPM). Univariate, multivariate, and propensity score weighted analyses were performed to compare study groups and overall mortality (OM). Results: A total of 2,467 (23.25%) CPM and 8,146 (76.75%) no-CPM cases were identified. Median follow-up was 58.64 months. In comparison to no-CPM patients, CPM patients were more likely to be younger (Mean:52, SD:11.5 vs. Mean:57.9,SD: 13), be White, AmericanIndian or non-Hispanic, have a private insurance, have higher education and income, have less comorbidities, with an ER+/PR+/HER2+ tumor (p<0.001). Performing CPM vs. no-CPM was not associated with the stage of the disease - Stage I (22-29% vs. 53-71%), II (64-20% vs. 257- 80%), or III (2,381-23% vs. 7,836-77%), p=0.17. The rate of CPM significantly increased from 13.70% in 2004 to 28.98% in 2014 (p<0.001). CPM was associated with a lower 90-day OM compared to no-CPM (0.85% vs. 1.83%, p=0.002). There was no association between CPM and 30-day OM or 30-day readmission (both p>0.05). In the adjusted propensity score weighted analysis, CPM was not associated with OM in Stage I (HR:0.61, p=0.32) and Stage II cases (HR:0.79, p=0.34); however, there was evidence of 34% lower hazard of OM in CPM compared to no-CPM in stage III (HR: 0.66, p<0.001) cases. Conclusions: Our data suggest that there might be a survival benefit to performing CPM in Stage III IBC patients. This conclusion is limited as NCDB does not report the reason and indications for performing CPM. Additional large studies exploring this association further should be performed.




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