本研究采用了单一机构的队列，Severance数据集，通过使用监测、流行病学和最终结果（SEER）数据库进行验证，通过倾向性评分匹配（PSM）进行调整，并使用机器学习方法进行分析。研究旨在确定进行乳头保留乳房切除术（NSM）伴即时乳房重建术（IBR）的患者的5年无病生存（DFS）和总生存（OS）是否不逊于接受全乳房切除术/保留皮肤的乳房切除术（TM/SSM）治疗的女性的情况。Severance数据集纳入了2010年至2017年间的611例早期浸润性乳腺癌患者。SEER数据集包含了2000年至2018年间进行TM术和NSM术的485,245例患者和14,770例患者的数据。所有患者均接受了乳房切除术和IBR术。NSM组进行了乳晕周围组织的术中冰冻切片活检。使用手术类型（包括TM/SSM和NSM）提取了SEER数据集。主要结果是Severance数据集的DFS和SEER数据集的OS。应用PSM分析。使用Kaplan-Meier方法和Cox比例风险（Cox PH）回归模型分析了生存结果。我们实施了XGBSE来预测死亡率，并使用一致性指数评估模型预测性能。最终模型使用shapley加法解释（SHAP）值检查了相关预测因子对模型输出的影响。在Severance数据集中，151例患者接受了NSM伴IBR，460例患者接受了TM/SSM伴IBR。两组之间没有显著差异。在多变量分析中，NSM与减少的肿瘤学结果无关。PSM分析得出相同结果。根据SHAP值，在SEER数据集中，个体特征的贡献表明AJCC分期排名第一。从两个数据集的分析结果证实了两种手术方法对生存结果的影响很小。NSM伴IBR在肿瘤学结果方面是一种安全可行的手术。使用机器学习方法进行分析可以成功地识别肿瘤学结果的显著风险因素。© 2023. 外科肿瘤学协会。

This study used a single-institution cohort, the Severance dataset, validated the results by using the surveillance, epidemiology, and end results (SEER) database, adjusted with propensity-score matching (PSM), and analyzed by using a machine learning method. To determine whether the 5-year, disease-free survival (DFS) and overall survival (OS) of patients undergoing nipple-sparing mastectomy (NSM) with immediate breast reconstruction (IBR) are not inferior to those of women treated with total mastectomy/skin-sparing mastectomy (TM/SSM).The Severance dataset enrolled 611 patients with early, invasive breast cancer from 2010 to 2017. The SEER dataset contained data for 485,245 patients undergoing TM and 14,770 patients undergoing NSM between 2000 and 2018. All patients underwent mastectomy and IBR. Intraoperative, frozen-section biopsy for the retro-areolar tissue was performed in the NSM group. The SEER dataset was extracted by using operation types, including TM/SSM and NSM. The primary outcome was DFS for the Severance dataset and OS for the SEER dataset. PSM analysis was applied. Survival outcomes were analyzed by using the Kaplan-Meier method and Cox proportional hazard (Cox PH) regression model. We implemented XGBSE to predict mortality with high accuracy and evaluated model prediction performance using a concordance index. The final model inspected the impact of relevant predictors on the model output using shapley additive explanation (SHAP) values.In the Severance dataset, 151 patients underwent NSM with IBR and 460 patients underwent TM/SSM with IBR. No significant differences were found between the groups. In multivariate analysis, NSM was not associated with reduced oncologic outcomes. The same results were observed in PSM analysis. In the SEER dataset, according to the SHAP values, the individual feature contribution suggested that AJCC stage ranks first. Analyses from the two datasets confirmed no impact on survival outcomes from the two surgical methods.NSM with IBR is a safe and feasible procedure in terms of oncologic outcomes. Analysis using machine learning methods can be successfully applied to identify significant risk factors for oncologic outcomes.© 2023. Society of Surgical Oncology.