Cassidy Michael R, Zabor Emily C, Stempel Michelle, Mehrara Babak, Gemignani Mary L
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Breast J. 2018 Jul;24(4):567-573. doi: 10.1111/tbj.12977. Epub 2018 Jan 8.
Neo-adjuvant chemotherapy (NAC) is administered in breast cancer treatment for downstaging of disease. Here, we determined the impact of response to NAC on breast reconstruction uptake. A prospective NAC and mastectomy database with or without reconstruction were reviewed with IRB approval. Univariable analyses were conducted using Kruskal-Wallis or Fisher's exact tests. Multivariable logistic regression was used to adjust for potential confounders. We identified 271 patients with unilateral breast cancer receiving NAC and either unilateral or bilateral mastectomy from 9/2013 to 5/2016. Seventy patients (25.8%) had a pCR to NAC. One hundred and seventy-five patients (64.6%) had immediate reconstruction (IR), and 96 had no IR. On univariable analysis, younger age (P < .001), lower T-stage at presentation (P < .001), bilateral versus unilateral mastectomy (P<.001) and HR-negative tumor subtype (P = .006) were significantly associated with higher IR rates. On multivariable analysis, pCR (P = .792) and tumor subtype (P = 0.061) were not significantly associated with IR; T-stage was significantly associated with IR (P < .001), such that patients with T4 tumors at presentation had lower odds of IR (OR 0.10, 95% CI 0.02-0.50), even when accounting for response to NAC. One hundred and seventy-three patients (63.8%) received adjuvant radiation therapy; this was associated with lower IR frequency (P = .048) but was not associated with reconstruction type (tissue expander versus autologous, P = 1.0) among 175 patients who had IR. In patients who have mastectomy after NAC, IR is influenced by age, T-stage at presentation, and choice of bilateral mastectomy, but not by response to NAC. A subset of patients who are young, with earlier T-stage and pCR, is more likely to proceed with bilateral mastectomy.
新辅助化疗（NAC）用于乳腺癌治疗以降低疾病分期。在此，我们确定了NAC反应对乳房重建接受率的影响。在获得机构审查委员会（IRB）批准后，对一个有或无重建的前瞻性NAC和乳房切除术数据库进行了回顾。使用Kruskal-Wallis检验或Fisher精确检验进行单变量分析。多变量逻辑回归用于调整潜在的混杂因素。我们确定了2013年9月至2016年5月期间接受NAC及单侧或双侧乳房切除术的271例单侧乳腺癌患者。70例患者（25.8%）对NAC达到病理完全缓解（pCR）。175例患者（64.6%）进行了即刻重建（IR），96例未进行IR。单变量分析显示，年龄较小（P <.001）、初诊时T分期较低（P <.001）、双侧与单侧乳房切除术（P<.001）以及激素受体（HR）阴性肿瘤亚型（P =.006）与较高的IR率显著相关。多变量分析显示，pCR（P =.792）和肿瘤亚型（P = 0.061）与IR无显著关联；T分期与IR显著相关（P <.001），以至于初诊时为T4肿瘤的患者进行IR的几率较低（比值比0.10，95%置信区间0.02 - 0.50），即使考虑NAC反应也是如此。173例患者（63.8%）接受了辅助放疗；这与较低的IR频率相关（P =.048），但在175例进行IR的患者中与重建类型（组织扩张器与自体组织，P = 1.0）无关。在NAC后进行乳房切除术的患者中，IR受年龄、初诊时T分期和双侧乳房切除术的选择影响，但不受NAC反应影响。一部分年轻、T分期较早且达到pCR的患者更有可能进行双侧乳房切除术。
