Health-Related Quality of Life After Nipple-Sparing Mastectomy: Results From the INSPIRE Registry
Antonio J Esgueva 1 , Iris Noordhoek 2 , Elma Meershoek-Klein Kranenbarg 2 , Martin Espinosa-Bravo 3 , Zoltán Mátrai 4 , Andrii Zhygulin 5 , Arvids Irmejs 6 , Carlos Mavioso 7 , Francesco Meani 8 , Eduardo González 9 , Murat Özdemir 10 , Tanir Allweis 11 , Karol Rogowski 12 , Catarina Rodrigues Dos Santos 13 , Henrique Mora 14 , Riccardo Ponzone 15 , Domenico Samorani 16 , Cornelis van de Velde 2 , Riccardo A Audisio 17 , Isabel T Rubio 18 , INSPIRE collaborators group
Introduction: Nipple-sparing mastectomy (NSM) with immediate breast reconstruction (IBR) is increasingly used for both breast cancer (TNSM) and risk reduction (RRNSM). The aim of the study is to report the results of the INSPIRE registry assessing health-related quality of life (HRQoL) comparing baseline and 1-year follow-up, regarding surgical indications and chemotherapy (CT) received.
Methods: INSPIRE is a prospective database including women undergoing NSM and IBR from 18 countries. HRQoL was measured using EORTC QLQC30 and QLQ-BR23 before surgery and after 1 year.
Results: A total of 677 women were included, of whom 537 (79.3%) underwent TNSM and 140 (21.6%) RRNSM: in total, 806 NSM (556 TNSM and 250 RRNSM). Nipple involvement was present in 7.73% of TNSM and incidental carcinoma in 1.2% of the RRNSM group. Out of the overall 537 patients with systemic treatment, 177 (32.96%) received neoadjuvant chemotherapy (NCT) and 118 (21.92%) adjuvant chemotherapy (CT). A total of 227 patients (28.16%) developed at least one complication postoperatively, 164 (29.5%) in the TNSM group and 63 (25.2%) in the RRNSM group. The TNSM group improved in global health status and emotional functioning after 1 year. No differences were found when comparing HRQoL at 1 year between patients who received NCT and those who received adjuvant CT. The RRNSM group showed improvement in HRQoL, with better emotional functioning and fatigue after 1 year.
Conclusions: This registry reports HRQoL findings after NSM. The impact of CT on worse HRQoL is independent from its timing. Patients with RRNSM showed an improved HRQoL at 1-year follow-up. Discussion of HRQoL outcomes with patients will facilitate the informed decision-making when considering NSM.