Ryu Jai Min, Paik Hyun-June, Park Sungmin, Yi Ha Woo, Nam Seok Jin, Kim Seok Won, Lee Se Kyung, Yu Jonghan, Bae Soo Youn, Lee Jeong Eon
Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Breast Cancer. 2017 Mar;20(1):74-81. doi: 10.4048/jbc.2017.20.1.74. Epub 2017 Mar 24.
The use of immediate breast reconstruction (IBR) following total mastectomy (TM) has increased markedly in patients with breast cancer. As the indications for IBR have been broadened and more breast-conserving surgery-eligible patients are undergoing IBR, comparing the oncologic safety between TM only and IBR following TM becomes more difficult. This study aimed to analyze the oncologic outcomes between TM only and IBR following TM via a matched case-control methodology.
A retrospective review was conducted to identify all patients who underwent TM between 2008 and 2014. We excluded patients who underwent neoadjuvant chemotherapy, including palliative chemotherapy, and had a follow-up duration <12 months, inflammatory breast cancer, or incomplete data. We divided the remaining patients into two groups: those who underwent TM only (control group) and those who underwent IBR following TM (study group). The groups were propensity score-matched. Matched variables included age, pathologic stage, estrogen or progesterone receptor status, human epidermal growth factor receptor 2 status, and year of operation.
After matching, 878 patients were enrolled in the control group and 580 patients in the study group. The median follow-up duration was 43.4 months (range, 11-100 months) for the control group and 41.3 months (range, 12-100 months) for the study group (=1.000). The mean age was 47.3±8.46 years for the control group and 43.9±7.14 years for the study group (>0.050). Matching was considered successful for the matching variables and other factors, such as family history, histology, multiplicity, and lymphovascular invasion. There were no significant differences in overall survival (log-rank =0.454), disease-free survival (log-rank =0.186), local recurrence-free survival (log-rank =0.114), or distant metastasis-free survival rates (logrank =0.537) between the two groups.
Our results suggest that IBR following TM is a feasible treatment option for patients with breast cancer.
在乳腺癌患者中，全乳切除术后即刻乳房重建（IBR）的应用显著增加。随着IBR的适应证不断扩大，越来越多适合保乳手术的患者接受IBR，比较单纯全乳切除（TM）与TM后IBR之间的肿瘤学安全性变得更加困难。本研究旨在通过匹配病例对照方法分析单纯TM与TM后IBR之间的肿瘤学结局。
进行回顾性研究，以确定2008年至2014年间所有接受TM的患者。我们排除了接受新辅助化疗（包括姑息化疗）、随访时间<12个月、炎性乳腺癌或数据不完整的患者。我们将其余患者分为两组：单纯接受TM的患者（对照组）和TM后接受IBR的患者（研究组）。两组进行倾向评分匹配。匹配变量包括年龄、病理分期、雌激素或孕激素受体状态、人表皮生长因子受体2状态和手术年份。
匹配后，对照组纳入878例患者，研究组纳入580例患者。对照组的中位随访时间为43.4个月（范围11 - 100个月），研究组为41.3个月（范围12 - 100个月）（=1.000）。对照组的平均年龄为47.3±8.46岁，研究组为43.9±7.14岁（>0.050）。对于匹配变量以及家族史、组织学、肿瘤多灶性和淋巴管浸润等其他因素，匹配被认为是成功的。两组之间的总生存率（对数秩检验=0.454）、无病生存率（对数秩检验=0.186）、无局部复发生存率（对数秩检验=0.114）或无远处转移生存率（对数秩检验=0.537）均无显著差异。
我们的结果表明，TM后IBR是乳腺癌患者的一种可行治疗选择。
