title: Overall Survival, Disease-Free Survival, Local Recurrence, and Nipple-Areolar Recurrence in the Setting of Nipple-Sparing Mastectomy: A Meta-Analysis and Systematic Review.
abstract: BACKGROUND
  Nipple-sparing mastectomy (NSM) is an increasingly common procedure; however, concerns exist regarding its oncological safety due to the potential for residual breast tissue to harbor occult malignancy or future cancer.
  
  
  METHODS
  A systematic literature review was performed. Studies with internal comparison arms evaluating therapeutic NSM versus skin-sparing mastectomy (SSM) and/or modified radical mastectomy (MRM) were included in a meta-analysis of overall survival (OS), disease-free survival (DFS), and local recurrence (LR). Studies lacking comparison arms were only included in the systematic review to evaluate mean OS, DFS, LR, and nipple-areolar recurrence (NAR).
  
  
  RESULTS
  The search yielded 851 articles. Twenty studies with 5594 patients met selection criteria. The meta-analysis included eight studies with comparison arms. Seven studies that compared OS found a 3.4% risk difference between NSM and MRM/SSM, five studies that compared DFS found a 9.6% risk difference between NSM and MRM/SSM, and eight studies that compared LR found a 0.4% risk difference between NSM and MRM/SSM. Risk differences for all outcomes were not statistically significant. The systematic review included all 20 studies and evaluated OS, DFS, LR, and NAR. Studies with follow-up intervals of <3 years, 3-5 years, and >5 years had mean OS of 97.2, 97.9, and 86.8%; DFS of 93.1, 92.3, and 76.1%; LR of 5.4, 1.4, and 11.4%; and NAR of 2.1, 1.0, and 3.4%, respectively.
  
  
  CONCLUSIONS
  This study did not detect adverse oncologic outcomes of NSM in carefully selected women with early-stage breast cancer. Use of prospective data registries, notably the Nipple-Sparing Mastectomy Registry, will add clarity to this important clinical question.
authors.affiliation: Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA, lcruzclaver@gmail.com.
authors.forename: Lucy
authors.initials: L
authors.lastname: De La Cruz
authors.forename: Alison M
authors.initials: AM
authors.lastname: Moody
authors.forename: Erryn E
authors.initials: EE
authors.lastname: Tappy
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Blankenship
authors.forename: Eric M
authors.initials: EM
authors.lastname: Hecht
mesh_terms: D001943:Breast Neoplasms / Q000401:mortality / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D016462:Mammaplasty; D015411:Mastectomy, Modified Radical / Q000009:adverse effects* / Q000401:mortality; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D009558:Nipples / Q000601:surgery*; D059351:Organ Sparing Treatments / Q000401:mortality; D011379:Prognosis; D015996:Survival Rate