Santosa Katherine B, Qi Ji, Kim Hyungjin M, Hamill Jennifer B, Pusic Andrea L, Wilkins Edwin G
Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI.
Center for Statistical Consultation and Research, Department of Biostatistics, University of Michigan, Ann Arbor, MI.
J Am Coll Surg. 2016 Dec;223(6):745-754. doi: 10.1016/j.jamcollsurg.2016.09.003. Epub 2016 Oct 26.
Although >40% of new breast cancer diagnoses in the US are in older women, few studies have assessed the outcomes of post-mastectomy reconstruction in this population. Our objective was to evaluate age effects on postoperative complications and patient-reported outcomes in women undergoing breast reconstruction, and to investigate whether age effects differ between reconstructive procedure types.
Eligible patients in the Mastectomy Reconstruction Outcomes Consortium study from 11 institutions (57 providers) in North America were analyzed. Two-year complications and patient-reported outcomes via BREAST-Q domains were compared across younger (younger than 45 years), middle-aged (45 to 60 years), and older (older than 60 years) women. Mixed-effects regression models were used, controlling for a range of demographic and clinical covariates.
A total of 1,531 patients were studied: 494 younger, 803 middle-aged, and 234 older. Age was not a significant predictor of complications. For sexual well-being 2 years post-reconstruction, older women reported 4.25 (p = 0.04) higher mean scores with implant procedures, and 10.39 (p < 0.01) higher mean scores with autologous procedures compared with younger women. No age effect was seen with implant procedures with regard to physical and psychosocial well-being; however, older women who underwent autologous procedures reported 6.07 (p < 0.01) higher physical, and 8.21 (p < 0.01) higher psychosocial well-being scores than younger women.
Age did not significantly affect complication rates. Older women demonstrated higher sexual well-being for both procedures, and better satisfaction and physical and psychosocial well-being than younger women with autologous procedures. Post-mastectomy reconstruction is a viable option for older patients, with risks and benefits comparable with those in younger women.
尽管美国超过40%的新发乳腺癌诊断病例发生在老年女性中，但很少有研究评估该人群乳房切除术后重建的结果。我们的目的是评估年龄对接受乳房重建女性术后并发症和患者报告结局的影响，并调查年龄影响在不同重建手术类型之间是否存在差异。
对来自北美11家机构（57名提供者）的乳房切除术后重建结局联盟研究中的符合条件患者进行分析。比较了年轻（小于45岁）、中年（45至60岁）和老年（大于60岁）女性两年的并发症情况以及通过BREAST-Q领域得出的患者报告结局。使用混合效应回归模型，并控制一系列人口统计学和临床协变量。
共研究了1531名患者：494名年轻患者、803名中年患者和234名老年患者。年龄不是并发症的显著预测因素。在重建后两年的性健康方面，与年轻女性相比，老年女性在植入手术中的平均得分高4.25（p = 0.04），在自体组织手术中的平均得分高10.39（p < 0.01）。在身体和心理社会健康方面，植入手术未观察到年龄影响；然而，接受自体组织手术的老年女性在身体和心理社会健康方面的得分分别比年轻女性高6.07（p < 0.01）和8.21（p < 0.01）。
年龄并未显著影响并发症发生率。老年女性在两种手术中的性健康状况均较高，并且与接受自体组织手术的年轻女性相比，满意度更高，身体和心理社会健康状况更好。乳房切除术后重建对于老年患者是一个可行的选择，其风险和益处与年轻女性相当。
