重建队列中对侧预防性乳房切除术选择及患者对复发担忧的评估
An Evaluation of the Choice for Contralateral Prophylactic Mastectomy and Patient Concerns About Recurrence in a Reconstructed Cohort.
作者信息
Sando Ian C, Billig Jessica I, Ambani Shoshana W, Kraft Casey T, Kidwell Kelley M, Zhong Lin, Chung Kevin C, Momoh Adeyiza O
出版信息
Ann Plast Surg. 2018 Apr;80(4):333-338. doi: 10.1097/SAP.0000000000001258.
BACKGROUND
Rising contralateral prophylactic mastectomy rates are a subject of national concern. This study assessed (1) factors critical to patients when deciding on contralateral prophylactic mastectomy and (2) patients' quality of life related to concerns about recurrence after unilateral or bilateral breast reconstruction.
METHODS
Patients with stage 0 to III breast cancer who underwent unilateral mastectomy or contralateral prophylactic mastectomy and breast reconstruction at a single institution between 2000 and 2012 were identified. Demographic and clinical data were extracted by chart review. Women's fears about breast cancer recurrence were assessed using the Concerns About Recurrence Scale, and motivational factors for contralateral prophylactic mastectomy were identified using the Decisions for Contralateral Prophylactic Mastectomy Survey.
RESULTS
Survey responses were received from 157 patients (59%) who underwent unilateral reconstruction and 109 (41%) who underwent bilateral reconstruction. The top 3 reasons for choosing contralateral prophylactic mastectomy were (1) decreasing the risk of contralateral breast disease (97%), (2) peace of mind (96%), and (3) improved survival (93%). Women who chose contralateral prophylactic mastectomy reported significantly greater overall fear and worry compared with the unilateral group, specifically, greater fears of dying and worries about adequately fulfilling roles of daily life (P < 0.05).
CONCLUSIONS
Despite no proven survival benefit, women chose contralateral prophylactic mastectomy primarily to optimize oncologic outcomes. Among breast reconstruction patients, women who underwent contralateral prophylactic mastectomy had greater anxiety and overall fear of breast cancer recurrence compared with those who chose unilateral mastectomy. These findings are important to consider when counseling women contemplating contralateral prophylactic mastectomy.
背景
对侧预防性乳房切除术（CPM）比例的上升引起了全国关注。本研究评估了（1）患者在决定是否进行对侧预防性乳房切除术时的关键因素，以及（2）与单侧或双侧乳房重建后对复发的担忧相关的患者生活质量。
方法
确定2000年至2012年间在单一机构接受单侧乳房切除术或对侧预防性乳房切除术及乳房重建的0至III期乳腺癌患者。通过病历审查提取人口统计学和临床数据。使用复发担忧量表评估女性对乳腺癌复发的恐惧，并使用对侧预防性乳房切除术决策调查确定对侧预防性乳房切除术的动机因素。
结果
共收到157例（59%）接受单侧重建患者和109例（41%）接受双侧重建患者的调查回复。选择对侧预防性乳房切除术的前三大原因是：（1）降低对侧乳腺疾病风险（97%），（2）安心（96%），（3）提高生存率（93%）。与单侧组相比，选择对侧预防性乳房切除术的女性报告的总体恐惧和担忧明显更大，具体而言，对死亡的恐惧更大，对充分履行日常生活角色的担忧更多（P<0.05）。
结论
尽管未证实对生存率有益处，但女性选择对侧预防性乳房切除术主要是为了优化肿瘤学结局。在乳房重建患者中，与选择单侧乳房切除术的女性相比，接受对侧预防性乳房切除术的女性对乳腺癌复发的焦虑和总体恐惧更大。在为考虑对侧预防性乳房切除术的女性提供咨询时，这些发现很重要，值得考虑。
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