Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden.
Br J Surg. 2018 Oct;105(11):1435-1445. doi: 10.1002/bjs.10866. Epub 2018 Apr 23.
Postmastectomy reconstruction using a deep inferior epigastric perforator (DIEP) flap is increasingly being performed in patients with breast cancer. The procedure induces extensive tissue trauma, and it has been hypothesized that the release of growth factors, angiogenic agonists and immunomodulating factors may reactivate dormant micrometastasis. The aim of the present study was to estimate the risk of breast cancer recurrence in patients undergoing DIEP flap reconstruction compared with that in patients treated with mastectomy alone.
Each patient who underwent delayed DIEP flap reconstruction at Karolinska University Hospital, Sweden, between 1999 and 2013, was compared with up to four controls with breast cancer who did not receive a DIEP flap. The control patients were selected using incidence density matching with respect to age, tumour and nodal status, neoadjuvant therapy and year of mastectomy. The primary endpoint was breast cancer-specific survival. Survival analysis was carried out using Kaplan-Meier survival estimates and Cox proportional hazard regression analysis.
The analysis included 250 patients who had 254 DIEP flap reconstructions and 729 control patients. Median follow-up was 89 and 75 months respectively (P = 0·053). Breast cancer recurrence developed in 50 patients (19·7 per cent) in the DIEP group and 174 (23·9 per cent) in the control group (P = 0·171). The 5-year breast cancer-specific survival rate was 92·0 per cent for patients with a DIEP flap and 87·9 per cent in controls (P = 0·032). Corresponding values for 5-year overall survival were 91·6 and 84·7 per cent (P < 0·001). After adjustment for tumour and patient characteristics and treatment, patients without DIEP flap reconstruction had significantly lower overall but not breast cancer-specific survival.
The present findings do not support the hypothesis that patients with breast cancer undergoing DIEP flap reconstruction have a higher rate of breast cancer recurrence than those who have mastectomy alone.
乳腺癌患者越来越多地采用腹壁下动脉穿支皮瓣（DIEP）进行乳房再造术。该手术会引起广泛的组织创伤，有人假设释放生长因子、血管生成激动剂和免疫调节因子可能会重新激活休眠的微转移。本研究旨在评估与单纯乳房切除术相比，接受 DIEP 皮瓣重建的患者乳腺癌复发的风险。
1999 年至 2013 年期间，在瑞典卡罗林斯卡大学医院接受延迟 DIEP 皮瓣重建的每位患者均与 4 名未接受 DIEP 皮瓣的乳腺癌对照患者进行比较。对照患者通过年龄、肿瘤和淋巴结状态、新辅助治疗和乳房切除术年份的发病率密度匹配进行选择。主要终点是乳腺癌特异性生存。使用 Kaplan-Meier 生存估计和 Cox 比例风险回归分析进行生存分析。
该分析包括 250 例患者，共进行了 254 次 DIEP 皮瓣重建，以及 729 名对照患者。中位随访时间分别为 89 个月和 75 个月（P=0.053）。DIEP 组中有 50 例（19.7%）和对照组中有 174 例（23.9%）患者发生乳腺癌复发（P=0.171）。DIEP 皮瓣组和对照组患者的 5 年乳腺癌特异性生存率分别为 92.0%和 87.9%（P=0.032）。相应的 5 年总生存率分别为 91.6%和 84.7%（P<0.001）。在调整肿瘤和患者特征以及治疗因素后，未接受 DIEP 皮瓣重建的患者总生存率较低，但乳腺癌特异性生存率无显著差异。
本研究结果不支持接受 DIEP 皮瓣重建的乳腺癌患者比单纯接受乳房切除术的患者乳腺癌复发率更高的假说。
