Department of Breast Surgery, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
Department of Breast Surgery, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
Clin Breast Cancer. 2019 Feb;19(1):e135-e141. doi: 10.1016/j.clbc.2018.10.013. Epub 2018 Nov 5.
Controversy exists regarding the appropriateness of immediate breast reconstruction (IBR) in patients with metastatic breast cancer (MBC).
By using the Surveillance, Epidemiology, and End Results (SEER) database, data of patients with de novo MBC undergoing mastectomy with or without IBR were assessed. The trend of IBR in de novo MBC was explored. Comparisons of the distribution of clinicopathologic characteristics were evaluated by chi-square and Fisher exact tests. The predictors of IBR in de novo MBC were evaluated by multivariate logistic regression. The survival outcomes were compared by Cox hazards models adjusting for known clinicopathologic variables in both the entire population and in the matched cohorts.
Between 1998 and 2015, 5.2% of patients with de novo MBC undergoing mastectomy received IBR. The rate of IBR increased significantly, from 6.3% in 1998 to 16.8% in 2015. Patients undergoing IBR were younger and had smaller tumor size, fewer positive lymph nodes, lower proportion of hormone receptor-negative disease and lung metastasis, and better economic status. They were also more likely to receive radiotherapy and chemotherapy. Although IBR was an independent favorable prognostic factor for breast cancer-specific survival and overall survival in the whole population, there were no statistically significant differences between IBR and mastectomy for breast cancer-specific survival (P = .892) and overall survival (P = .708) in the well-matched analysis.
IBR in selected de novo MBC could be an acceptable practice when balancing quality of life, underlying health care burden, and oncologic risks.
对于转移性乳腺癌（MBC）患者是否适合立即进行乳房重建（IBR）存在争议。
通过使用监测、流行病学和最终结果（SEER）数据库，评估了接受乳房切除术伴或不伴 IBR 的初发 MBC 患者的数据。探讨了初发 MBC 中 IBR 的趋势。通过卡方和 Fisher 确切检验评估了临床病理特征分布的比较。通过多变量逻辑回归评估了初发 MBC 中 IBR 的预测因素。通过 Cox 风险模型调整了全人群和匹配队列中已知的临床病理变量，比较了生存结果。
1998 年至 2015 年期间，5.2%接受乳房切除术的初发 MBC 患者接受了 IBR。IBR 的比率显著增加，从 1998 年的 6.3%增加到 2015 年的 16.8%。接受 IBR 的患者年龄较小，肿瘤体积较小，阳性淋巴结较少，激素受体阴性疾病和肺转移的比例较低，经济状况较好。他们也更有可能接受放疗和化疗。尽管 IBR 是全人群乳腺癌特异性生存和总生存的独立有利预后因素，但在良好匹配的分析中，IBR 与乳房切除术在乳腺癌特异性生存（P=0.892）和总生存（P=0.708）方面没有统计学差异。
在平衡生活质量、潜在医疗保健负担和肿瘤学风险的情况下，对选定的初发 MBC 进行 IBR 可能是一种可接受的做法。
