From the Divisions of Plastic and Reconstructive Surgery and Surgical Oncology, Department of Surgery, Duke University Medical Center; the Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Duke University; the Division of Plastic Surgery, Henry Ford Health System; and the Division of Plastic Surgery, Depart PRS-D-19-00046 ment of Surgery, Brigham and Women's Hospital.
Plast Reconstr Surg. 2020 Mar;145(3):595-604. doi: 10.1097/PRS.0000000000006535.
Breast cancer survival continues to improve, with women living longer after treatment. It is not well understood how long-term satisfaction and well-being differ following treatment or how types of reconstruction differ when compared to the norm.
In a propensity-matched sample, the authors compared patient-reported outcomes in breast cancer patients at various time intervals from surgery with normative BREAST-Q data. All data were obtained using the Army of Women, an online community fostering breast cancer research. Breast cancer patients were stratified by surgical treatment and reconstruction type. Regression lines were estimated and differences in slope tested between cancer patients and noncancer controls.
The authors compared normative (n = 922) and breast cancer (n = 4343) cohorts in a propensity-matched analysis. Among the breast cancer patients, 49.4 percent underwent lumpectomy, 17.0 percent underwent mastectomy, 21.7 percent underwent implant reconstruction, and 11.9 percent underwent autologous reconstruction. Median time since surgery was 4.7 years, with 21.1 percent more than 10 years after surgery. At the time of survey, breast cancer patients reported higher Satisfaction with Breasts and Psychosocial Well-being scores compared to noncancer controls (p < 0.01), with the cohorts undergoing lumpectomy and autologous reconstruction both reporting higher scores than the normative controls. After mastectomy, scores averaged lower than the noncancer controls, but improved over time. However, all breast cancer groups reported significantly lower Physical Well-being scores than the noncancer cohort (all p < 0.01).
Breast cancer patients undergoing lumpectomy or autologous reconstruction reported higher psychosocial well-being compared to noncancer controls. These differences were influenced both by time since treatment and by choice of surgical procedure.
乳腺癌患者的存活率持续提高，治疗后生存时间延长。但目前尚不清楚治疗后患者的长期满意度和幸福感有何差异，也不清楚与常规治疗相比，不同类型的重建术有何差异。
在倾向匹配样本中，作者比较了不同时间间隔（从手术开始）的乳腺癌患者和 BREAST-Q 标准数据的患者报告结果。所有数据均来自于妇女军队（一个促进乳腺癌研究的在线社区）。根据手术治疗和重建类型对乳腺癌患者进行分层。估计回归线，并检验癌症患者和非癌症对照之间斜率的差异。
作者在倾向匹配分析中比较了标准（n=922）和乳腺癌（n=4343）队列。在乳腺癌患者中，49.4%接受了保乳手术，17.0%接受了乳房切除术，21.7%接受了植入物重建，11.9%接受了自体组织重建。中位手术时间为 4.7 年，21.1%的患者手术后超过 10 年。在调查时，乳腺癌患者报告的乳房满意度和心理社会幸福感评分高于非癌症对照组（p<0.01），接受保乳手术和自体组织重建的患者评分均高于标准对照组。乳房切除术后，评分平均低于非癌症对照组，但随时间推移而改善。然而，所有乳腺癌组的身体幸福感评分均明显低于非癌症组（均 p<0.01）。
接受保乳手术或自体组织重建的乳腺癌患者报告的心理社会幸福感高于非癌症对照组。这些差异既受治疗后时间的影响，也受手术程序选择的影响。
