M. Mahmoud1, D. Crystal1, P. Shah1, N. Taunk1, R. Broach1, S. Azoury1, O. Fayanju1 1University Of Pennsylvania, Philadelphia, PA, USA
Introduction: Triple-negative breast cancer is an aggressive subtype disproportionately diagnosed among Black women as compared to White women. Autologous breast reconstruction (ABR) after mastectomy is associated with significant aesthetic and psychological benefits. While rare, postoperative complications can delay next steps in treatment and even result in death. It is unclear if receipt of autologous reconstruction is associated with adverse oncologic outcomes for patients with TNBC and if there are observed racial disparities in outcomes. We sought to examine and compare overall survival and recurrence rates after autologous breast reconstruction among Black and White patients with TNBC.
Methods: We identified females ≥18 yo diagnosed with invasive triple-negative carcinoma at our institution between 2007 and 2017 and who underwent ABR. We collected data on demographics, breast tumor data, systemic and radiation treatment composition and sequence, intraoperative details, reconstruction complication and revision information, recurrence, and mortality. Cox proportional models were used to estimate hazard ratios of the potential recurrence and mortality differences by race. Survival times were measured from the date of surgery to date of death or date of last contact.
Results: We included 135 patients in the analysis: 34 Black, 89 White, 4 Asian/Pacific Islander, and 8 with unknown race/ethnicity. A majority of patients had Stage II disease: clinical stages 1 (42, 32%), 2 (65, 51%), 3 (15, 11%), and 4 (3, 2%). There were 47 (35%) patients with nodal involvement. More patients received neoadjuvant therapy first (59, 56%) compared to those who received surgery first (46, 44%). Median time to cancer recurrence and mortality was 5.97 and 6.45 years, respectively. Mean age at diagnosis was 48.53 years while mean body mass index (BMI) was 29.78 kg/m2. There were 87 (64%) patients who never smoked, 6 (4%) who currently smoked and 42 (31%) who smoked prior to surgery. Transverse rectus abdominis myocutaneous flap (TRAM) (61% for left breast and 58% for right breast) and deep inferior epigastric perforator (DIEP) flaps (21% for left breast and 26% for right breast) were the most common autologous reconstruction procedures. Of the 135 patients, 38 (28%) patients had their breast cancer recur and 34 (25%) patients died. There were no differences in mortality (p=0.29) or recurrence (p=0.47) by race/ethnicity, and neither smoking nor obesity status affected risk of mortality or recurrence.
Conclusion: There were no significant differences in recurrence or mortality by race after mastectomy and ABR for TNBC patients. Further investigation with larger patient samples could identify risk factors that better predict adverse outcomes.