术前放疗与乳房切除术后短期发病率增加无关：对77902例患者的分析
Preoperative Radiotherapy Is Not Associated with Increased Post-mastectomy Short-term Morbidity: Analysis of 77,902 Patients.
作者信息
Baltodano Pablo A, Reinhardt Myrna Eliann, Flores José M, Abreu Francis M, Chattha Anmol, Kone Lyonell, Cooney Carisa M, Manahan Michele A, Zellars Richard C, Rosson Gedge D
机构信息
Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD; Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD; Department of Plastic and Reconstructive Surgery, Albany Medical Center, Albany, NY; and Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, MD.
出版信息
Plast Reconstr Surg Glob Open. 2017 Mar 13;5(3):e1108. doi: 10.1097/GOX.0000000000001108. eCollection 2017 Mar.
BACKGROUND
Neoadjuvant radiotherapy (NRT) enhances breast-conserving surgery outcomes, reducing local recurrence of breast cancer and increasing median survival. However, its effect on postoperative morbidity remains under-studied. We sought to assess the impact of NRT on 30-day postoperative morbidity after mastectomy.
METHODS
We analyzed data from women undergoing mastectomy (with or without immediate reconstruction) using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) 2005-2011 datasets. ACS-NSQIP is a prospective, risk-adjusted, outcomes-based registry. Data included demographic and perioperative factors. Outcomes studied included surgical site (wound and prosthesis/flap complications), systemic (cardiac, respiratory, neurological, urinary, and venous thromboembolism events), and overall morbidity. Logistic regression was used to estimate the unadjusted odds ratio (uOR) and adjusted odds ratio (aOR) between NRT and postoperative 30-day morbidity.
RESULTS
The study population included 77,902 women, of which 61,039 (78.4%) underwent mastectomy only and 16,863 (21.6%) underwent mastectomy with immediate breast reconstruction. NRT was administered to 266 (0.4%) mastectomy-only and 75 (0.4%) immediate breast reconstruction patients. In the mastectomy-only group, there were no significant differences in the rates of postoperative surgical site morbidity (aOR = 1.41; 95% confidence interval (CI): 0.76-2.63; = 0.276), systemic morbidity (aOR = 0.72; 95% CI: 0.40-1.26; = 0.252), and overall morbidity (aOR = 0.85; 95% CI: 0.54-1.33; = 0.477) between NRT and control groups. Similarly, no significant differences were found for these three outcomes in the immediate breast reconstruction population. Statistical power for every comparison was >80%.
CONCLUSIONS
This study suggests that NRT is not associated with significantly higher 30-day postoperative complications among breast cancer patients undergoing mastectomy with or without immediate breast reconstruction.
背景
新辅助放疗（NRT）可改善保乳手术效果，降低乳腺癌局部复发率并延长中位生存期。然而，其对术后发病率的影响仍研究不足。我们旨在评估NRT对乳房切除术后30天发病率的影响。
方法
我们使用美国外科医师学会国家外科质量改进计划（ACS-NSQIP）2005 - 2011年数据集，分析了接受乳房切除术（有或无即刻乳房重建）的女性数据。ACS-NSQIP是一个前瞻性、风险调整、基于结果的登记系统。数据包括人口统计学和围手术期因素。研究的结果包括手术部位（伤口和假体/皮瓣并发症）、全身性（心脏、呼吸、神经、泌尿和静脉血栓栓塞事件）以及总体发病率。采用逻辑回归来估计NRT与术后30天发病率之间的未调整比值比（uOR）和调整比值比（aOR）。
结果
研究人群包括77,902名女性，其中61,039名（78.4%）仅接受乳房切除术，16,863名（21.6%）接受即刻乳房重建的乳房切除术。266名（0.4%）仅接受乳房切除术和75名（0.4%）即刻乳房重建患者接受了NRT。在仅乳房切除组中，NRT组与对照组在术后手术部位发病率（aOR = 1.41；95%置信区间（CI）：0.76 - 2.63；P = 0.276）、全身性发病率（aOR = 0.72；95% CI：0.40 - 1.26；P = 0.252）和总体发病率（aOR = 0.85；95% CI：0.54 - 1.33；P = 0.477）方面无显著差异。同样，在即刻乳房重建人群中，这三个结果也未发现显著差异。每次比较的统计效能均>80%。
结论
本研究表明，在接受或未接受即刻乳房重建的乳房切除术后乳腺癌患者中，NRT与30天术后并发症显著增加无关。
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