Xavier Harmeling J, Kouwenberg Casimir A E, Bijlard Eveline, Burger Koert N J, Jager Agnes, Mureau Marc A M
Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
Breast Cancer Res Treat. 2015 Sep;153(2):241-51. doi: 10.1007/s10549-015-3539-4. Epub 2015 Aug 19.
Adjuvant chemotherapy is often needed to achieve adequate breast cancer control. The increasing popularity of immediate breast reconstruction (IBR) raises concerns that this procedure may delay the time to adjuvant chemotherapy (TTC), which may negatively impact oncological outcome. The current systematic review aims to investigate this effect. During October 2014, a systematic search for clinical studies was performed in six databases with keywords related to breast reconstruction and chemotherapy. Eligible studies met the following inclusion criteria: (1) research population consisted of women receiving therapeutic mastectomy, (2) comparison of IBR with mastectomy only groups, (3) TTC was clearly presented and mentioned as outcome measure, and (4) original studies only (e.g., cohort study, randomized controlled trial, case-control). Fourteen studies were included, representing 5270 patients who had received adjuvant chemotherapy, of whom 1942 had undergone IBR and 3328 mastectomy only. One study found a significantly shorter mean TTC of 12.6 days after IBR, four studies found a significant delay after IBR averaging 6.6-16.8 days, seven studies found no significant difference in TTC between IBR and mastectomy only, and two studies did not perform statistical analyses for comparison. In studies that measured TTC from surgery, mean TTC varied from 29 to 61 days for IBR and from 21 to 60 days for mastectomy only. This systematic review of the current literature showed that IBR does not necessarily delay the start of adjuvant chemotherapy to a clinically relevant extent, suggesting that in general IBR is a valid option for non-metastatic breast cancer patients.
通常需要辅助化疗来实现对乳腺癌的充分控制。即刻乳房重建（IBR）越来越受欢迎，这引发了人们对该手术可能会延迟辅助化疗开始时间（TTC）的担忧，而这可能会对肿瘤治疗结果产生负面影响。当前的系统评价旨在研究这种影响。2014年10月，在六个数据库中对与乳房重建和化疗相关的关键词进行了临床研究的系统检索。符合条件的研究满足以下纳入标准：（1）研究人群包括接受治疗性乳房切除术的女性；（2）IBR组与单纯乳房切除术组的比较；（3）明确呈现TTC并将其作为结局指标提及；（4）仅纳入原始研究（如队列研究、随机对照试验、病例对照研究）。共纳入14项研究，代表5270例接受辅助化疗的患者，其中1942例接受了IBR，3328例仅接受了乳房切除术。一项研究发现IBR后平均TTC显著缩短至12.6天，四项研究发现IBR后有显著延迟，平均延迟6.6 - 16.8天，七项研究发现IBR与单纯乳房切除术之间的TTC无显著差异，两项研究未进行统计学分析以作比较。在从手术开始测量TTC的研究中，IBR的平均TTC为29至61天，单纯乳房切除术的平均TTC为21至60天。对当前文献的这项系统评价表明，IBR不一定会将辅助化疗的开始延迟到临床相关程度，这表明总体而言，IBR对于非转移性乳腺癌患者是一个有效的选择。
