Agarwal Shailesh, Kidwell Kelley M, Farberg Aaron, Kozlow Jeffrey H, Chung Kevin C, Momoh Adeyiza O
Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA.
Ann Surg Oncol. 2015 Aug;22(8):2551-9. doi: 10.1245/s10434-014-4326-x. Epub 2015 Jan 7.
Immediate, implant-only breast reconstruction is traditionally discouraged in patients who receive radiation. It is not clear whether this widely recognized mantra of breast reconstruction is observed in practice. The purpose of this study was to evaluate immediate reconstruction trends and practices in patients who have undergone mastectomy and radiation therapy.
Female patients with unilateral breast cancer who required radiation in addition to mastectomy were extracted from the Surveillance, Epidemiology, and End Results (SEER) database from 2000 through 2010. Patients who underwent immediate reconstruction were identified and analyzed. Univariate and logistic regression analyses were performed to study the relationship between reconstructive method and patient demographic and oncologic characteristics.
A total of 5,481 female patients who underwent radiation and breast reconstruction were included for analysis. Postmastectomy radiation therapy was performed in 98.3 % of the patients. The immediate breast reconstruction rate among patients requiring radiation increased from 13.6 to 25.1 %. The percentage of reconstructed patients who had implant-only reconstruction increased from 27 to 52 % (p < 0.001) with a decrease in tissue-only reconstruction from 56 to 32 % (p < 0.001). In regression analysis, the odds of implant reconstruction over autologous reconstruction increased each year by an odds ratio of 1.13 (95 % CI 1.10-1.15).
The frequency of immediate reconstruction continues to increase in the setting of postmastectomy radiation therapy, with immediate implant-based reconstruction representing the most commonly utilized method, contrary to traditional recommendations. These findings likely reflect changing attitudes towards implant reconstruction in the setting of planned postmastectomy radiation.
传统上不鼓励接受放疗的患者进行即刻仅植入物乳房重建。目前尚不清楚在实际操作中是否遵循了这种广为认可的乳房重建原则。本研究的目的是评估接受乳房切除术和放疗患者的即刻重建趋势及实践情况。
从2000年至2010年的监测、流行病学和最终结果（SEER）数据库中提取除乳房切除术外还需要放疗的单侧乳腺癌女性患者。确定并分析接受即刻重建的患者。进行单因素和逻辑回归分析以研究重建方法与患者人口统计学和肿瘤学特征之间的关系。
共有5481例接受放疗和乳房重建的女性患者纳入分析。98.3%的患者进行了乳房切除术后放疗。需要放疗的患者中即刻乳房重建率从13.6%升至25.1%。仅植入物重建的重建患者百分比从27%增至52%（p<0.001），仅组织重建从56%降至32%（p<0.001）。在回归分析中，植入物重建相对于自体重建的优势比每年以1.13的优势比增加（95%CI 1.10 - 1.15）。
在乳房切除术后放疗的情况下，即刻重建的频率持续增加，与传统建议相反，即刻基于植入物的重建是最常用的方法。这些发现可能反映了在计划进行乳房切除术后放疗的情况下对植入物重建态度的转变。
