Yale School of Medicine, Department of Surgery, Section of Plastic and Reconstructive Surgery, New Haven, CT, USA.
Yale School of Medicine, Department of Surgery, Section of Plastic and Reconstructive Surgery, New Haven, CT, USA.
Eur J Surg Oncol. 2019 Apr;45(4):584-590. doi: 10.1016/j.ejso.2019.01.016. Epub 2019 Jan 17.
Racial disparities among patients who receive breast mastectomy and reconstruction have not been well characterized.
Records of patients undergoing breast extirpative and reconstructive surgery at a high-volume university-affiliated hospital over 5 consecutive years were reviewed. Patient demographics, breast cancer profiles, reconstructive modality, and outcomes were compared by race.
A total of 1045 patients underwent 1678 breast reconstructions during the five-year period. Mean age and standard deviation was 49.8 ± 10.6 years with a BMI of 27.9 ± 6.5. Hispanic and African American patients had significantly higher BMIs (p < 0.001), higher rates of ASA class III or IV (p = 0.025), obesity, diabetes, hypertension (p < 0.001 for these three comparisons), and smoking (p = 0.003), and had more prior abdominal surgeries (p = 0.007). Comparing oncologic characteristics, this population subset had higher rates of neoadjuvant chemotherapy (p = 0.036), history of radiation (p = 0.016), and were more likely to undergo modified radical mastectomy (p = 0.002) over nipple-sparing mastectomy (p = 0.035). Reconstructive complications revealed a higher overall complication rate (p = 0.023), higher rates of partial mastectomy flap necrosis (p = 0.043), as well as arterial (p = 0.009) and venous insufficiency (p = 0.026) during microvascular reconstruction among Hispanic and African American patients.
Compared to other patients, the present study identifies higher comorbidity burdens, higher rates of prior radiation and neoadjuvant chemotherapy, and higher post-surgical complication rates among Hispanic and African American patients with breast cancer.
接受乳房切除术和重建的患者中存在种族差异，但这些差异尚未得到充分描述。
回顾了一家高容量大学附属医院连续 5 年接受乳房切除术和重建手术的患者记录。按种族比较患者人口统计学特征、乳腺癌特征、重建方式和结果。
在 5 年期间，共有 1045 名患者接受了 1678 次乳房重建。平均年龄和标准差为 49.8±10.6 岁，BMI 为 27.9±6.5。西班牙裔和非裔美国患者的 BMI 明显更高（p<0.001），ASA 分级 III 或 IV 级的比例更高（p=0.025），肥胖、糖尿病、高血压（这三个比较均 p<0.001）和吸烟（p=0.003）更为常见，且有更多的腹部手术史（p=0.007）。比较肿瘤学特征，这部分患者人群接受新辅助化疗的比例更高（p=0.036），有放疗史的比例更高（p=0.016），更倾向于接受改良根治性乳房切除术（p=0.002）而不是保留乳头的乳房切除术（p=0.035）。重建并发症显示总体并发症发生率更高（p=0.023），部分乳房皮瓣坏死发生率更高（p=0.043），以及在接受微血管重建的西班牙裔和非裔美国患者中动脉（p=0.009）和静脉功能不全（p=0.026）的发生率更高。
与其他患者相比，本研究确定了西班牙裔和非裔美国乳腺癌患者的合并症负担更高、放疗和新辅助化疗的比例更高，以及术后并发症发生率更高。
