乳腺癌患者乳房切除术（重建或不重建）后的生存和疾病复发率。
Survival and Disease Recurrence Rates among Breast Cancer Patients following Mastectomy with or without Breast Reconstruction.
机构信息
From the Department of Hygiene, Epidemiology, and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens; the Department of Plastic and Reconstructive Surgery and the Department of Surgery, The Johns Hopkins Hospital; and the Bloomberg School of Public Health, Johns Hopkins University.
出版信息
Plast Reconstr Surg. 2019 Aug;144(2):169e-177e. doi: 10.1097/PRS.0000000000005798.
BACKGROUND
Concerns have been expressed about the oncologic safety of breast reconstruction following mastectomy for breast cancer. This study aimed to evaluate the association of breast reconstruction with breast cancer recurrence, and 5-year survival among breast cancer patients.
METHODS
The authors analyzed data from The Johns Hopkins Hospital comprehensive cancer registry, comparing mastectomy-only to postmastectomy breast reconstruction in breast cancer patients to evaluate differences in breast cancer recurrence and 5-year survival. Kaplan-Meier curves were used to compare unadjusted estimates of survival or disease recurrence. Data were modeled through Cox proportional hazards regression, using as outcomes time to death from any cause or time to cancer recurrence.
RESULTS
The authors analyzed data on 1517 women who underwent mastectomy for breast cancer at The Johns Hopkins hospital between 2003 and 2015. Of these, 504 (33.2 percent) underwent mastectomy only and 1013 (66.8 percent) underwent mastectomy plus immediate breast reconstruction. Women were followed up for a median of 5.1 years after diagnosis. There were 132 deaths and 100 breast cancer recurrences. A comparison of Kaplan-Meier survival estimates demonstrated a survival benefit among patients undergoing mastectomy plus reconstruction. After adjusting for various clinical and socioeconomic variables, there was still an overall survival benefit associated with breast reconstruction which, however, was not statistically significant (hazard ratio, 0.78; 95 percent CI, 0.53 to 1.13). Patients who underwent reconstruction had a similar rate of recurrence compared to mastectomy-only patients (hazard ratio, 1.08; 95 percent CI, 0.69 to 1.69).
CONCLUSION
This study suggests that breast reconstruction does not have a negative impact on either overall survival or breast cancer recurrence rates.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
背景
对于乳腺癌乳房切除术（mastectomy）后的乳房重建的肿瘤安全性，人们表示担忧。本研究旨在评估乳腺癌患者乳房重建与乳腺癌复发和 5 年生存率的关系。
方法
作者分析了约翰霍普金斯医院综合癌症登记处的数据，将仅行乳房切除术与乳房切除术加乳房重建的乳腺癌患者进行比较，以评估乳腺癌复发和 5 年生存率的差异。Kaplan-Meier 曲线用于比较生存或疾病复发的未经调整估计值。使用 Cox 比例风险回归对数据进行建模，以死亡的任何原因或癌症复发的时间为结局。
结果
作者分析了 2003 年至 2015 年在约翰霍普金斯医院行乳房切除术治疗乳腺癌的 1517 名女性的数据。其中，504 名（33.2%）仅行乳房切除术，1013 名（66.8%）行乳房切除术加即刻乳房重建。女性在诊断后中位随访 5.1 年。有 132 人死亡，100 人发生乳腺癌复发。Kaplan-Meier 生存估计值的比较显示，接受乳房切除术加重建的患者有生存获益。调整了各种临床和社会经济变量后，重建与总体生存获益相关，但无统计学意义（风险比，0.78；95%CI，0.53 至 1.13）。接受重建的患者与仅行乳房切除术的患者相比，复发率相似（风险比，1.08；95%CI，0.69 至 1.69）。
结论
本研究表明，乳房重建对总体生存率或乳腺癌复发率没有负面影响。
临床问题/证据水平：治疗性，III 级。
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