Taussig Cancer Institute, Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio.
Taussig Cancer Institute, Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio.
Pract Radiat Oncol. 2019 Nov;9(6):e497-e505. doi: 10.1016/j.prro.2019.06.008. Epub 2019 Jun 22.
The toxicity profile of breast reconstruction with postmastectomy radiation therapy (PMRT) varies by technique and timing, and long-term data are limited. We compared rates of complications requiring reoperation (CRR) and reconstruction failure (RF) between immediate autologous reconstruction (I-AR), immediate tissue expander/implant reconstruction (I-TE/I), delayed autologous reconstruction (D-AR), and delayed tissue expander/implant reconstruction (D-TE/I) in patients receiving PMRT.
Patients who received autologous reconstruction (AR) or tissue expander/implant reconstruction (TE/I) and PMRT between 2000 to 2008 were included. Reconstruction was immediate if performed on the same day as mastectomy followed by PMRT (I-AR or I-TE/I) or delayed if after PMRT (D-AR and D-TE/I). CRR was defined as an unplanned return to the operating room for infection, dehiscence, necrosis, hematoma, or hernia (with AR) and extrusion, leak, or contracture (with TE/I). RF was defined as unplanned conversion to another reconstruction technique or to flat chest wall. Cumulative incidence of CRR and RF was calculated using Kaplan-Meier and compared using the log-rank test. Logistic regression was used to identify variables associated with CRR and RF.
Two hundred four patients were included. Median follow-up was 8 years. There were 127 AR cases (63%) and 77 TE/I cases (38%). At 5 years, CRR was 18%, 38%, 34%, and 70% (P = .010) and RF was 4%, 22%, 7%, and 56% (P < .0001) for I-AR, I-TE/I, D-AR, and D-TE/I, respectively. On multivariate analysis, TE/I (hazard ratio [HR] 2.0; P = .011), body mass index ≥30 (HR 3.9; P = .002), and smoking (HR 2.7; P = .001) were significant predictors for CRR, and TE/I (HR 6.6; P < .0001), diabetes (HR 4.1; P = .044), and hypertension (HR 3.5; P = .005) were significant for RF. When excluding RF because of infection, the rate of RF was not significantly different among the 4 groups (P = .23).
With PMRT, TE/I reconstruction in the immediate and delayed setting is associated with higher CRR and RF compared with AR. Patient factors should guide selection of technique. Efforts to reduce rates of RF with TE/I should focus on minimizing risks for infection.
乳房重建伴乳腺癌根治术后放疗（PMRT）的毒性谱因技术和时间而异，且长期数据有限。我们比较了即刻自体重建（I-AR）、即刻组织扩张器/植入物重建（I-TE/I）、延迟自体重建（D-AR）和延迟组织扩张器/植入物重建（D-TE/I）患者中需要再次手术的并发症发生率（CRR）和重建失败（RF）率。
纳入了 2000 年至 2008 年间接受自体重建（AR）或组织扩张器/植入物重建（TE/I）和 PMRT 的患者。如果在乳房切除术的同一天进行重建（I-AR 或 I-TE/I），则为即刻重建，如果在 PMRT 后进行重建（D-AR 和 D-TE/I），则为延迟重建。CRR 定义为因感染、裂开、坏死、血肿或疝（AR）和脱出、泄漏或挛缩（TE/I）而计划外返回手术室。RF 定义为计划改为另一种重建技术或改为扁平胸壁。使用 Kaplan-Meier 计算 CRR 和 RF 的累积发生率，并使用对数秩检验比较。使用逻辑回归确定与 CRR 和 RF 相关的变量。
共纳入 204 例患者。中位随访时间为 8 年。有 127 例 AR 病例（63%）和 77 例 TE/I 病例（38%）。5 年时，CRR 分别为 18%、38%、34%和 70%（P=0.010），RF 分别为 4%、22%、7%和 56%（P<0.0001），I-AR、I-TE/I、D-AR 和 D-TE/I。多变量分析显示，TE/I（风险比[HR] 2.0；P=0.011）、体重指数≥30（HR 3.9；P=0.002）和吸烟（HR 2.7；P=0.001）是 CRR 的显著预测因素，而 TE/I（HR 6.6；P<0.0001）、糖尿病（HR 4.1；P=0.044）和高血压（HR 3.5；P=0.005）是 RF 的显著预测因素。由于感染导致 RF 排除后，4 组间 RF 发生率无显著差异（P=0.23）。
PMRT 时，即刻和延迟 TE/I 重建与 AR 相比，CRR 和 RF 更高。患者因素应指导技术选择。应努力降低 TE/I 的 RF 发生率，重点降低感染风险。
