Resultado estético y calidad de vida en pacientes con cáncer de mama tratadas con cirugia conservadora después de tratamiento sistémico primario

Abstract

In the last decade, primary systemic therapy (PST) for breast cancer has gained prominence due to its ability to increase the rate of breast-conserving surgery (BCS). This prospective study evaluates the quality of life, aesthetic outcomes, and patient satisfaction following BCS after PST, from both the patient’s and the surgical team’s perspectives. Materials and Methods A total of 146 patients treated between May 2016 and December 2018 were included. Quality of life was assessed using the EORTC C30 and B23 questionnaires, and aesthetic outcomes were evaluated using a four-point Likert scale by both the patient and the surgeon. Additionally, the BCCT.core software and an external panel of observers were used. Assessments were conducted before surgery, at one month, six months, one year, and two years post-surgery. Results The mean patient age was 55 years (range 32-84). Most tumors were cT2 (71.9%), with 48.5% of patients classified as cN0 and 44.5% as cN1. A significant improvement in quality of life was observed from baseline to two-year follow-up (63.6 to 74.0; p=0.010), particularly in functional scales and symptom reduction. However, quality of life worsened after one year in patients >55 years old (72.3 vs 62; p=0.008) and those receiving adjuvant endocrine therapy (74.7 vs 64.1; p=0.022). At two years, this decline persisted in women ≥55 years (79.6 vs 68.4; p=0.009) and was more pronounced in patients undergoing axillary lymphadenectomy (82.3 vs 67.6; p<0.001). Aesthetic outcomes, as rated by patients, remained stable with a high proportion of excellent/good ratings (81.6%-87.4%). However, surgeons' evaluations became more critical over time, with positive ratings decreasing from 94.8% at one month to 85.7% at two years (p=0.032). A strong correlation was found between aesthetic outcomes and patient satisfaction (Spearman coefficient 0.703; p<0.001). Factors negatively affecting aesthetic results included age ≥65 years (OR 3.7; p=0.025), smoking (OR 6.4; p=0.005 at one year and OR 9.5; p=0.005 at two years), and large breast size (OR 4.4; p=0.043). Patient satisfaction was lower in cases where wire localization was used instead of intraoperative ultrasound (OR 6.3; p=0.045), when surgical specimen volume was ≥50 cm³ (OR 6.6; p=0.02), and in smokers (OR 11.4; p=0.008). Additionally, reoperations were strongly associated with lower satisfaction at six months (OR 63.1; p=0.005). Aesthetic concordance analysis showed better correlation between patient and surgeon assessments (IK 0.26-0.43) and between BCCT.core and external observers (IK 0.03-0.51). Satisfaction concordance between patient and surgeon improved over time (IK 0.27 at one month and 0.38 at two years). Conclusions Overall quality of life improved over time, though it was negatively affected by older age, endocrine therapy, and lymphadenectomy. Better aesthetic outcomes were associated with higher patient satisfaction, while factors such as smoking, wire localization, larger surgical specimen volume, large breast size, and reoperation negatively impacted aesthetic results and satisfaction. Over time, surgeons became more critical of aesthetic outcomes, whereas patient perception remained more stable. While aesthetic evaluation concordance was higher between patient and surgeon, and between BCCT.core and external observers, correlations were generally low to moderate

Date of Award	23 May 2025
Original language	Spanish
Supervisor	Isabel Teresa Rubio Rodriguez (Director) & Christian Sisó Raber (Director)