The recurrence outcome with respect to treatment choices in idiopathic granulomatous mastitis: A retrospective cohort study with 10-year single-center experience

Abstract

Background: This study aimed to investigate the recurrence outcome with respect to treatment choices in patients with idiopathic granulomatous mastitis (IGM). Methods: A total of 175 female patients (mean +/- SD age: 36.3 +/- 8.9 years) with histopathologically confirmed IGM were included in this retrospective cohort study. Data on patient age, presenting symptoms, treatment protocols (medical and/or surgery), the recurrence rate, recurrence-free survival (RFS) and progression-free survival (PFS) were recorded. RFS time (month) and PFS and time (month) were compared across medical treatment subgroups (antibiotic, steroid, steroid-sparing immunosuppressant). Results: The treatment protocols involved surgery plus medical treatment in 82(46.9 %) patients, medical treatment alone in 82(46.9) and surgery alone in 11(6.2 %) patients. The medical treatment included the immunosuppressive therapy (42.1 %), antibiotic therapy (29.3 %) and steroid therapy (28.7 %). Within a median 36 months of follow-up, recurrence was noted in 64(39.5 %) patients and was significantly more common in the surgery plus medical treatment group than in the medical treatment alone group (53.7 % vs. 25.0 %, p < 0.001). Overall, median (95 % CI) RFS time and PFS time were 29(21.9-36.1) months and 12(5.8-18.2) months, respectively. No significant difference was noted between medical treatment subgroups in terms of RFS time (log-rank p value: 0.176) and PFS time (log-rank p value: 0.421). Nonetheless, immunosuppressive therapy showed a non-significant tendency for longer RFS (vs. steroid therapy) and longer PFS (vs. both antibiotic and steroid therapy). Conclusions: In conclusion, this retrospective cohort study in patients with IGM revealed the association of systemic therapy, particularly the steroid-sparing immunosuppressive treatment, with favorable long-term RFS and PFS outcome. (c) 2025 Asian Surgical Association and Taiwan Society of Coloproctology. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/ by-nc-nd/4.0/).