Bowen Megan E, Mone Mary C, Buys Saundra S, Sheng Xiaoming, Nelson Edward W
*Department of Surgery, University of Utah Health Sciences Center, Salt Lake City, UT †Department of Medicine, University of Utah Health Sciences Center, Salt Lake City, UT ‡Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City, UT.
Ann Surg. 2017 Mar;265(3):448-456. doi: 10.1097/SLA.0000000000001804.
To evaluate the risk of neoadjuvant chemotherapy for surgical morbidity after mastectomy with or without reconstruction using 1:1 matching.
Postoperative surgical complications remain a potentially preventable event for breast cancer patients undergoing mastectomy. Neoadjuvant chemotherapy is among variables identified as contributory to risk, but it has not been rigorously evaluated as a principal causal influence.
Data from American College of Surgeons National Surgical Quality Improvement Program (2006-2012) were used to identify females with invasive breast cancer undergoing planned mastectomy. Surgical cases categorized as clean and undergoing no secondary procedures unrelated to mastectomy were included. A 1:1 matched propensity analysis was performed using neoadjuvant chemotherapy within 30 days of surgery as treatment. A total of 12 preoperative variables were used with additional procedure matching: bilateral mastectomy, nodal surgery, tissue, and/or implant. Outcomes examined were 4 wound occurrences, sepsis, and unplanned return to the operating room.
We identified 31,130 patient procedures with 2488 (7.5%) receiving chemotherapy. We matched 2411 cases, with probability of treatment being 0.005 to 0.470 in both cohorts. Superficial wound complication was the most common wound event, 2.24% in neoadjuvant-treated versus 2.45% in those that were not (P = 0.627). The rate of return to the operating room was 5.7% in the neoadjuvant group versus 5.2% in those that were not (P = 0.445). The rate of sepsis was 0.37% in the neoadjuvant group versus 0.46% in those that were not (P = 0.654).
This large, matched cohort study, controlled for preoperative risk factors and most importantly for the surgical procedure performed, demonstrates that breast cancer patients receiving neoadjuvant chemotherapy have no increased risk for surgical morbidity.
采用1:1匹配的方法评估新辅助化疗对接受或未接受乳房重建的乳房切除术后手术并发症的风险。
对于接受乳房切除术的乳腺癌患者，术后手术并发症仍是一个潜在可预防的事件。新辅助化疗是已确定的导致风险的变量之一，但尚未作为主要因果影响因素进行严格评估。
利用美国外科医师学会国家外科质量改进计划（2006 - 2012年）的数据，确定计划接受乳房切除术的浸润性乳腺癌女性患者。纳入分类为清洁手术且未进行与乳房切除术无关的二次手术的病例。以手术30天内接受新辅助化疗作为治疗方法进行1:1匹配的倾向分析。总共使用12个术前变量并进行额外手术匹配：双侧乳房切除术、淋巴结手术、组织和/或植入物。所检查的结果包括4种伤口情况、败血症和非计划重返手术室。
我们确定了31130例患者手术，其中2488例（7.5%）接受化疗。我们匹配了2411例病例，两组的治疗概率为0.005至0.470。浅表伤口并发症是最常见的伤口事件，新辅助治疗组为2.24%，未治疗组为2.45%（P = 0.627）。新辅助治疗组重返手术室的比例为5.7%，未治疗组为5.2%（P = 0.445）。新辅助治疗组败血症发生率为0.37%，未治疗组为0.46%（P = 0.654）。
这项大型匹配队列研究，对术前危险因素进行了控制，最重要的是对所进行的手术进行了控制，表明接受新辅助化疗的乳腺癌患者手术并发症风险没有增加。
