A.Kh. Ismagilov1, S.N. Sadygova2, P.A. Kotkov2, V.Yu. Mikhaylichenko3, B.V. Sigua2
1Kazan State Medical Academy ― Branch Campus of the FSBEI FPE RMACPE MOH Russia, Kazan
2I.I. Mechnikov North-Western State Medical University, Saint-Petersburg
3V.I. Vernadsky Crimean Federal University, S.I. Georgievsky Medical Academy, Simferopol
Kotkov Pavel A. ― Cand. of Sci. (Med.), Assistant of the Department of Faculty Surgery named after I.I. Grekov of the I.I. Mechnikov North-Western State Medical University
41 Kirochnaya Str., Saint-Petersburg, 191015, Russian Federation, tel. +7-906-261-92-31, e-mail: email@example.com, ORCID ID: 0000-0002-9762-9854
Introduction. The modern concept of decaying breast cancer treatment implies initial neoadjuvant therapy and the subsequent surgical treatment based on the results of the prescribed treatment. However, a number of works approve the beneficial effect of the primary tumor removal on the course of oncological process in patients with malignant diseases of other localizations – colon, skin, and kidneys.
Goal ― improving the survival of patients with decaying forms of breast cancer by revising the role and timing of surgery.
Material and methods. Based on the analysis of treatment results, obtained in 86 patients with decaying breast cancer, a number of clinical and histological factors were identified to be predictors of an unfavorable course of the disease. These parameters included the status of regional lymph nodes, hormonal parameters of the tumor, Ki67, the presence of visceral metastases, and the age of the patient. In accordance with the identified predictors, 90 patients of the main group were divided into three subgroups according to the degree of negative disease course risk. In the presence of high risk, patients underwent primary surgery as soon as possible; in medium risk patients surgery was performed after short-term neoadjuvant therapy. This approach is based on the assumption that early intervention at the primary oncological site helps to reduce the tumor burden and correct immune disorders. The effectiveness and safety of the described therapeutic approach was assessed by the structure of postoperative complications, 3-year overall and event-free survival. A statistically significant increase in overall three-year survival was achieved (from 69,3 to 76,8%) without a significant impact on event-free survival (69,1 and 68,9 for the comparison and main groups, respectively), as well as the frequency and structure of postoperative complications.
Conclusions. The practice of early surgery in selected patients with decaying breast cancer may improve overall 3-year survival without adverse affect on other outcomes.
Key words: decaying breast cancer, primary inoperable breast cancer, adjuvant, neoadjuvant therapy, mastectomy.