Cavallo Jaime A, Gangopadhyay Noopur, Dudas Jason, Roma Andres A, Jasielec Mateusz S, Baty Jack, Baalman Sara, Frisella Margaret M, Tenenbaum Marissa M, Myckatyn Terence M, Matthews Brent D, Deeken Corey R
From the *Section of Minimally Invasive Surgery, Department of Surgery, †Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO; ‡Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH; and §Department of Biostatistics, Washington University School of Medicine, St. Louis, MO.
Ann Plast Surg. 2015 Jul;75(1):74-83. doi: 10.1097/SAP.0000000000000538.
The study purpose was to evaluate the associations between patient characteristics and the histologic remodeling scores of acellular dermal matrices (ADMs) biopsied from breast reconstruction sites in the first attempt to generate a multivariable risk prediction model of nonconstructive remodeling. It was hypothesized that host characteristics and surgical site assessments predict the degree of graft remodeling for ADMs used during breast reconstruction.
The ADMs were biopsied from the breast reconstruction sites of n = 62 patients during a subsequent breast procedure, stained with hematoxylin-eosin, and evaluated according to a semi-quantitative scoring system for remodeling characteristics (cell types, cell infiltration, extracellular matrix deposition, scaffold degradation, fibrous encapsulation, and neovascularization) and a mean composite score. Biopsies were stained with Sirius Red and Fast Green, and analyzed to determine the collagen I:III ratio. Based on univariate analyses between subject clinical characteristics and the histologic remodeling scores, cohort variables were selected for multivariable regression models using a P value of 0.20 or less.
The composite score model yielded 3 variables: pack-year history, corticosteroid use, and radiation timing (r pseudo = 0.81). The model for collagen I yielded 2 variables: corticosteroid use and reason for reoperation (r pseudo = 0.78). The model for collagen III yielded 1 variable: reason for reoperation (r pseudo = 0.35).
These preliminary results constitute the first steps in generating a risk prediction model that predicts the patients and clinical circumstances most likely to experience nonconstructive remodeling of biologic grafts used to reconstruct the breast.
本研究旨在评估患者特征与首次从乳房重建部位活检的脱细胞真皮基质（ADM）组织学重塑评分之间的关联，以建立非建设性重塑的多变量风险预测模型。研究假设宿主特征和手术部位评估可预测乳房重建中使用的ADM的移植物重塑程度。
在后续乳房手术中，从n = 62例患者的乳房重建部位获取ADM活检样本，用苏木精-伊红染色，并根据重塑特征（细胞类型、细胞浸润、细胞外基质沉积、支架降解、纤维包裹和新生血管形成）的半定量评分系统和平均综合评分进行评估。活检样本用天狼星红和固绿染色，分析以确定I型与III型胶原蛋白比例。基于受试者临床特征与组织学重塑评分之间的单变量分析，选择队列变量用于多变量回归模型，P值≤0.20。
综合评分模型得出3个变量：吸烟包年史、使用皮质类固醇和放疗时间（r伪= 0.81）。I型胶原蛋白模型得出2个变量：使用皮质类固醇和再次手术原因（r伪= 0.78）。III型胶原蛋白模型得出1个变量：再次手术原因（r伪= 0.35）。
这些初步结果是建立风险预测模型的第一步，该模型可预测最有可能经历用于乳房重建的生物移植物非建设性重塑的患者和临床情况。
