Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Ann Surg Oncol. 2019 Apr;26(4):961-968. doi: 10.1245/s10434-018-07135-4. Epub 2019 Jan 23.
The aim of this study was to determine the impact of postmastectomy radiotherapy (PMRT) on reoperation rates in women with breast cancer undergoing mastectomy and breast reconstruction.
Between June 2001 and December 2015, 832 breast cancer patients treated with mastectomy and breast reconstruction with (n = 159) or without (n = 673) PMRT were analyzed retrospectively. Reoperations following breast reconstruction were categorized into the following three types: anticipated, unanticipated, and others. Multivariable logistic regression models were used to evaluate the impact of PMRT on overall and unanticipated reoperations according to different breast reconstruction types after adjusting for relevant covariates.
With a median follow-up of 58.5 months, a total of 1298 operations were performed in 832 breast cancer patients. The rates of overall and unanticipated reoperations were 46.2% and 7.7%, respectively. Multivariable analysis showed that PMRT was not associated with overall reoperations in either implant-based reconstruction patients (odds ratio [OR] 1.00, 95% confidence interval [CI] 0.43-2.37, p = 0.995) or autologous reconstruction patients (OR 0.85, 95% CI 0.52-1.40, p = 0.533); however, the impact of PMRT on unanticipated reoperations differed by reconstruction type. In patients who received implant-based reconstructions, PMRT was associated with a 3.05-fold (95% CI 1.20-7.75, p = 0.019) higher odds of unanticipated reoperations, while there was no difference in patients who underwent autologous reconstruction (OR 1.17, 95% CI 0.51-2.66, p = 0.713). Delayed reconstruction or delayed-immediate reconstructions were associated with an increased risk of both overall and unanticipated reoperations in both reconstruction cohorts.
PMRT appears to be associated with an increased risk of unanticipated reoperations among patients receiving implant-based reconstruction, but not among those receiving autologous reconstruction. The risk of reoperation should be taken into consideration when selecting the appropriate breast reconstruction type when PMRT is planned.
本研究旨在确定乳腺癌根治术后乳房重建患者中，术后放疗（PMRT）对再次手术率的影响。
回顾性分析 2001 年 6 月至 2015 年 12 月期间接受乳房切除术和乳房重建术的 832 例乳腺癌患者的资料，其中行 PMRT（n=159）或未行 PMRT（n=673）。根据不同的乳房重建类型，将乳房重建后的再次手术分为预期性、非预期性和其他类型。采用多变量逻辑回归模型，在调整相关协变量后，根据不同的乳房重建类型，评估 PMRT 对总体和非预期性再次手术的影响。
中位随访时间为 58.5 个月，832 例乳腺癌患者共进行了 1298 次手术。总体和非预期性再次手术的发生率分别为 46.2%和 7.7%。多变量分析显示，PMRT 与接受假体植入乳房重建术患者的总体再次手术（比值比 [OR] 1.00，95%置信区间 [CI] 0.43-2.37，p=0.995）或自体组织乳房重建术患者（OR 0.85，95% CI 0.52-1.40，p=0.533）均无关；然而，PMRT 对非预期性再次手术的影响因重建类型而异。在接受假体植入乳房重建术的患者中，PMRT 与非预期性再次手术的风险增加 3.05 倍（95% CI 1.20-7.75，p=0.019），而在接受自体组织乳房重建术的患者中，两者之间无差异（OR 1.17，95% CI 0.51-2.66，p=0.713）。延迟重建或延迟即刻重建与两种重建队列中总体和非预期性再次手术的风险增加有关。
PMRT 似乎与接受假体植入乳房重建术患者的非预期性再次手术风险增加有关，但与接受自体组织乳房重建术患者无关。当计划行 PMRT 时，应考虑再次手术的风险，选择合适的乳房重建类型。
