Division of Plastic & Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, 1020 N. Mason, Ste 110, St. Louis, MO, USA.
Diagnostic Radiology, University of Kansas Health System, Kansas City, KS, USA.
Breast Cancer Res Treat. 2020 Jun;181(3):611-621. doi: 10.1007/s10549-020-05639-w. Epub 2020 Apr 30.
We explored the impact of the relative volume of a tumor versus the entire breast on outcomes in patients undergoing breast conservation therapy (BCT) versus mastectomy and reconstruction (M + R). We hypothesized that there would be a threshold tumor:breast ratio (TBR) below which patient-reported outcomes (PRO) would favor BCT and above which would favor M + R.
We conducted a prospective cohort study of patients with ductal carcinoma in situ (DCIS) or invasive breast cancers undergoing BCT or M + R. A prerequisite for inclusion, analysis of tumor and breast volumes was conducted from three-dimensional magnetic resonance imaging reconstructions to calculate the TBR. Three-dimensional photography was utilized to calculate pre- and postoperative volumes and assess symmetry. Oncologic, surgical, and patient-reported outcome data were obtained from relevant BREAST-Q modules administered pre- and postoperatively.
The BCT cohort had significantly smaller tumor volumes (p = 0.001) and lower TBRs (p = 0.001) than patients undergoing M + R overall. The M + R group, however, comprised a broader range of TBRs, characterized at lower values by patients opting for contralateral prophylactic mastectomy. Postoperative satisfaction with breasts, psychosocial, and sexual well-being scores were significantly higher in the BCT cohort, while physical well-being significantly favored the M + R cohort 480.2 ± 286.3 and 453.1 ± 392.7 days later, respectively.
Relative to BCT, M + R was used to manage a broad range of TBRs. The relative importance of oncologic and surgical risk reduction, symmetry, and number of procedures can vary considerably and may limit the utility of TBR as a guide for deciding between BCT and M + R. Clinical Trial StatementThis study was registered with clinicaltrials.gov as "A Prospective Trial to Assess Tumor:Breast Ratio and Patient Satisfaction Following Lumpectomy Versus Mastectomy With Reconstruction", Identifier: NCT02216136.
我们探讨了肿瘤相对于整个乳房的相对体积对接受保乳治疗（BCT）与乳房切除术和重建（M+R）的患者结局的影响。我们假设，在低于某个肿瘤：乳房比值（TBR）的情况下，患者报告的结局（PRO）将倾向于 BCT，而高于该值时则倾向于 M+R。
我们对接受 BCT 或 M+R 的导管原位癌（DCIS）或浸润性乳腺癌患者进行了前瞻性队列研究。纳入分析的前提是，通过三维磁共振成像重建来分析肿瘤和乳房的体积，以计算 TBR。使用三维摄影来计算术前和术后的体积并评估对称性。从相关的 BREAST-Q 模块中获得肿瘤学、手术和患者报告的结局数据，这些数据是在术前和术后进行的。
BCT 组的肿瘤体积明显小于（p=0.001），TBR 也明显低于（p=0.001）接受 M+R 的患者。然而，M+R 组的 TBR 范围更广，特征是选择对侧预防性乳房切除术的患者 TBR 值较低。术后对乳房的满意度、心理社会和性健康评分在 BCT 组显著更高，而生理健康评分在 M+R 组显著更高，分别在 480.2±286.3 天和 453.1±392.7 天后。
与 BCT 相比，M+R 用于治疗广泛的 TBR。肿瘤学和手术风险降低、对称性和手术次数的相对重要性可能差异很大，这可能限制 TBR 作为决定 BCT 与 M+R 之间选择的指南的实用性。
本研究在 clinicaltrials.gov 上注册为“评估保乳切除术与乳房切除术和重建后肿瘤：乳房比值和患者满意度的前瞻性试验”，标识符：NCT02216136。
