Department of Surgery, University of North Carolina, Chapel Hill, NC; Division of Plastic Surgery, University of North Carolina, Chapel Hill, NC.
Department of Surgery, University of North Carolina, Chapel Hill, NC; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC.
Clin Breast Cancer. 2018 Aug;18(4):313-319. doi: 10.1016/j.clbc.2017.11.021. Epub 2017 Dec 7.
Despite the psychological benefits and oncologic safety of postmastectomy breast reconstruction, most breast cancer patients do not undergo reconstruction. To better understand the patterns of breast reconstruction usage, it is important to identify the clinicopathologic factors associated with immediate breast reconstruction (IBR), and whether modification of the reconstruction incidence when stratified by patient- or cancer-related factors exists in the breast cancer population. The primary objectives were to determine whether the incidence of immediate postmastectomy breast reconstruction varies across age, and whether the tumor grade or radiation therapy modify the effect of age on the incidence of immediate breast reconstruction.
Using the Surveillance, Epidemiology, and End Results database, we identified women who had undergone mastectomy for breast cancer from 2000 to 2014. Inverse probability of treatment-weighted log-binomial regression was used to estimate the effect of age on IBR after accounting for potential confounding by patient demographic data and cancer characteristics. Potential effect measure modification by tumor grade and radiation therapy on the age-IBR relationship was also assessed.
Of 321,206 women, 77,798 (24.2%) had undergone IBR. Age was significantly associated with IBR prevalence (P < .0001), with younger women more likely to undergo IBR. Both tumor grade (P < .0001) and radiation therapy (P < .0001) modified the effect of age on IBR.
Compared with their older counterparts, younger breast cancer patients were more likely to undergo IBR, and both tumor grade and radiation therapy were differentially associated with the likelihood of IBR across patient age.
尽管乳房再造术具有心理益处和肿瘤安全性，但大多数乳腺癌患者并未进行重建。为了更好地了解乳房重建的使用模式，重要的是要确定与即刻乳房重建（IBR）相关的临床病理因素，以及在乳腺癌患者中，根据患者或癌症相关因素分层时，重建发生率是否存在变化。主要目的是确定即刻乳房再造术的发生率是否因年龄而异，以及肿瘤分级或放疗是否改变了年龄对即刻乳房重建发生率的影响。
我们使用监测、流行病学和最终结果数据库，确定了 2000 年至 2014 年间因乳腺癌接受乳房切除术的女性。采用逆概率治疗加权对数二项式回归来估计年龄对 IBR 的影响，同时考虑了患者人口统计学数据和癌症特征的潜在混杂因素。还评估了肿瘤分级和放疗对年龄与 IBR 关系的潜在效应修饰作用。
在 321206 名女性中，有 77798 名（24.2%）接受了 IBR。年龄与 IBR 发生率显著相关（P<.0001），年轻女性更有可能接受 IBR。肿瘤分级（P<.0001）和放疗（P<.0001）均改变了年龄对 IBR 的影响。
与年龄较大的患者相比，年轻的乳腺癌患者更有可能接受 IBR，而肿瘤分级和放疗与患者年龄对 IBR 的可能性存在差异相关。
