Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul, South Korea.
Department of Plastic and Reconstructive Surgery, Dongguk University Medical Center, Goyang, South Korea.
BMC Cancer. 2020 Jan 30;20(1):78. doi: 10.1186/s12885-020-6568-2.
Although immediate breast reconstruction has been reported to be oncologically safe, no affirmative study comparing the two reconstruction methods exists. We investigated breast cancer recurrence rates in two breast reconstruction types; implant reconstruction and autologous flap reconstruction.
A retrospective cohort study was performed on propensity score-matched (for age, stage, estrogen receptor status) patients who underwent IBR after mastectomy at Seoul National University Hospital between 2010 and 2014. The main outcomes determined were locoregional recurrence-free interval (LRRFI) and disease-free interval (DFI).
We analyzed 496 patients among 731 patients following propensity score matching (Median age 43, 247 implant reconstruction and 249 flap reconstruction). During median follow-up of 58.2 months, DFI was not different between the two groups at each tumor stage. However, flap reconstruction showed inferior DFI compared to implant reconstruction in patients with high histologic grade (p = 0.012), and with high Ki-67 (p = 0.028). Flap reconstruction was related to short DFI in multivariate analysis in aggressive tumor subsets. Short DFI after flap reconstruction in aggressive tumor cell phenotype was most evident in hormone positive/Her-2 negative cancer (p = 0.008). LRRFI, on the other hand, did not show difference according to reconstruction method regardless of tumor cell aggressiveness.
Although there is no difference in cancer recurrence according to reconstruction method in general, flap-based reconstruction showed higher systemic recurrence associated with histologically aggressive tumors.
尽管即刻乳房重建已被报道为具有肿瘤安全性，但尚无比较两种重建方法的肯定性研究。我们研究了两种乳房重建类型（植入物重建和自体皮瓣重建）的乳腺癌复发率。
对 2010 年至 2014 年期间在首尔国立大学医院接受乳房切除术并进行 IBR 的患者进行了倾向评分匹配（针对年龄、分期、雌激素受体状态）的回顾性队列研究。主要观察结果是局部区域无复发生存期（LRRFI）和无病生存期（DFS）。
在进行倾向评分匹配后，我们分析了 731 例患者中的 496 例（中位年龄为 43 岁，247 例植入物重建和 249 例皮瓣重建）。在中位随访 58.2 个月期间，在每个肿瘤分期中，两组的 DFI 均无差异。然而，在高组织学分级（p=0.012）和高 Ki-67 （p=0.028）的患者中，皮瓣重建的 DFI 低于植入物重建。在多变量分析中，皮瓣重建与侵袭性肿瘤亚组的较短 DFI 相关。在激素阳性/Her-2 阴性癌症中（p=0.008），皮瓣重建后侵袭性肿瘤细胞表型的 DFI 较短。另一方面，无论肿瘤细胞侵袭性如何，LRRFI 均与重建方法无关。
尽管一般来说，重建方法与癌症复发无关，但基于皮瓣的重建与组织学侵袭性肿瘤相关的全身性复发较高。
