From the Section of Plastic Surgery, the Center for Statistical Consultation and Research, and the Department of Biostatistics, University of Michigan; and the Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School.
Plast Reconstr Surg. 2020 Jun;145(6):1029e-1036e. doi: 10.1097/PRS.0000000000006811.
The objective of this study was to determine whether women with a history of radiation therapy before mastectomy experience a risk for postoperative complications and patient-reported outcomes similar to those of women undergoing postmastectomy radiation therapy in the setting of immediate implant reconstruction.
The cohort included patients undergoing immediate implant reconstruction at 11 centers across North America. Women were categorized into three groups: prior breast conservation therapy, postmastectomy radiation therapy, and no radiation therapy. Mixed effect logistic regressions were used to analyze the effects of radiation therapy status on complication rates and patient-reported outcomes.
ONE THOUSAND FIVE HUNDRED NINETY-FOUR: patients were analyzed, including 84 women with prior breast conservation therapy, 329 women who underwent postmastectomy radiation therapy, and 1181 women with no history of radiation therapy. Compared with postmastectomy radiation therapy, breast conservation was associated with lower rates of all complications and major complications (OR, 0.65; 95 percent CI, 0.37 to 1.14; p = 0.13; and OR, 0.61; 95 percent CI, 0.33 to 1.13; p = 0.12). These differences were not statistically significant. Rates of reconstructive failure between the two cohorts were comparable. Before reconstruction, satisfaction with breasts was lowest for women with prior breast conservation therapy (p < 0.001). At 2 years postoperatively, satisfaction with breasts was lower for women with postmastectomy radiation therapy compared with breast conservation patients (p = 0.007).
Higher postoperative complication rates were observed in women exposed to radiation therapy regardless of timing. Although women with prior breast conservation experienced greater satisfaction with their breasts and fewer complications when compared to women undergoing postmastectomy radiation therapy, there was a similar risk for reconstruction failure.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
本研究旨在确定接受乳房切除术前行放射治疗的女性是否与即刻乳房植入重建术后接受辅助放疗的女性在术后并发症和患者报告结局方面存在相似的风险。
该队列纳入了北美 11 个中心进行即刻乳房植入重建的患者。女性分为三组：保乳治疗史、辅助放疗和无放疗。采用混合效应逻辑回归分析放疗状态对并发症发生率和患者报告结局的影响。
共分析了 1594 例患者，其中 84 例有保乳治疗史，329 例接受了辅助放疗，1181 例无放疗史。与辅助放疗相比，保乳治疗与所有并发症和主要并发症的发生率较低（OR，0.65；95%CI，0.37 至 1.14；p = 0.13；OR，0.61；95%CI，0.33 至 1.13；p = 0.12）。这些差异无统计学意义。两组患者的重建失败率相当。在重建前，有保乳治疗史的女性对乳房的满意度最低（p < 0.001）。术后 2 年，与保乳治疗患者相比，接受辅助放疗的女性对乳房的满意度较低（p = 0.007）。
无论放疗时机如何，接受放疗的女性术后并发症发生率较高。尽管与接受辅助放疗的女性相比，有保乳治疗史的女性对乳房的满意度更高且并发症更少，但重建失败的风险相似。
临床问题/证据水平：治疗性，II 级。
