Department of Surgery and Norris Comprehensive Cancer Center, Division of Breast, Soft Tissue and Endocrine Surgery, University of Southern California (USC), Los Angeles, California.
Department of Surgery, School of Medicine, Catholic University of Daegu, Daegu, South Korea.
J Surg Res. 2019 Jun;238:207-217. doi: 10.1016/j.jss.2019.01.010. Epub 2019 Feb 14.
This study was performed to determine if there was a difference in immediate breast reconstruction (IBR) rates between our public hospital and private cancer center, which share a common faculty with a consistent management philosophy in multidisciplinary care. We investigated the factors affecting postmastectomy reconstruction and IBR rates.
We retrospectively identified women with clinical stage I-II breast cancer who underwent mastectomy at our public hospital, Los Angeles County Medical Center, and our private cancer center, Keck Hospital of USC/Norris Comprehensive Cancer Center. Univariate and multivariate analyses were performed to study predictors of IBR and any breast reconstruction.
Of 293 mastectomy patients, the rate of any breast reconstruction at the private cancer (56.6%) center was higher than that at the public hospital (36.2%). IBR rates for the private cancer center (93.6%) and for patients with private insurance were higher than for the public hospital (40.8%) and likewise for those without insurance (86.7% versus 45.5%). In a multivariate analysis, the odds of IBR at our private cancer center were 22.96 times higher than that at our public hospital. Age >50 y and radiotherapy were independent predictive factors associated with less likelihood of any breast reconstruction.
Patients at the public hospital had a much lower rate of breast reconstruction than the private cancer center patients, even after controlling for stage and the team of treating physicians. Our results showed that older age and radiotherapy affect rates of breast reconstruction, as do hospital system and insurance status.
本研究旨在确定在我们的公立医院和私立癌症中心（它们拥有共同的教职员工，并在多学科治疗方面拥有一致的管理理念）之间，即时乳房重建（IBR）的比率是否存在差异。我们调查了影响乳腺癌根治术后重建和 IBR 率的因素。
我们回顾性地确定了在我们的公立医院——洛杉矶县医疗中心和私立癌症中心——南加州大学凯克医院/诺里斯综合癌症中心接受乳腺癌根治术的 I 期和 II 期临床乳腺癌患者。进行单变量和多变量分析以研究 IBR 和任何乳房重建的预测因素。
在 293 例乳腺癌根治术患者中，私立癌症中心（56.6%）的任何乳房重建率均高于公立医院（36.2%）。私立癌症中心（93.6%）和有私人保险的患者的 IBR 率高于公立医院（40.8%）和没有保险的患者（86.7%比 45.5%）。多变量分析显示，我们的私立癌症中心进行 IBR 的几率是公立医院的 22.96 倍。年龄>50 岁和放疗是与任何乳房重建可能性降低相关的独立预测因素。
即使在控制了分期和治疗医生团队之后，公立医院的患者乳房重建率仍远低于私立癌症中心的患者。我们的结果表明，年龄较大和放疗以及医院系统和保险状况均会影响乳房重建的几率。
