Lee Kyeong-Tae, Bae Juyoung, Jeon Byung Joon, Pyon Jai Kyong, Mun Goo-Hyun, Bang Sa Ik
Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Korea.
Ann Surg Oncol. 2021 Apr;28(4):2191-2198. doi: 10.1245/s10434-020-09177-z. Epub 2020 Sep 24.
In immediate two-stage implant-based breast reconstruction, adjuvant chemotherapy, when indicated, is usually conducted between the stages, which might influence the outcomes of the second-stage operation.
The purpose of this study was to evaluate the potential influence of adjuvant chemotherapy on the final outcomes of two-stage implant-based reconstructions.
Patients who underwent immediate tissue expander/implant breast reconstruction between 2010 and 2016, with completion of both stages, were reviewed. Cases were categorized into two groups-adjuvant chemotherapy and no adjuvant chemotherapy. The rates of adverse outcomes were compared between the groups.
A total of 602 cases in 568 patients were analyzed, with a mean follow-up period of 58.5 months, including 236 patients receiving adjuvant chemotherapy and 366 patients not receiving adjuvant chemotherapy. The two groups had similar baseline characteristics, except for a significantly higher rate of adjuvant radiotherapy in the former group. The adjuvant chemotherapy group showed significantly higher rates of overall complications (odds ratio [OR] 2.127, 95% confidence interval [CI] 1.231-3.676), including infections (OR 4.239, 95% CI 1.059-16.970), severe capsular contractures (OR 2.107, 95% CI 1.067-4.159), and reconstruction failures (OR 12.754, 95% CI 1.587-102.481) compared with the control group, after adjusting for other variables, including adjuvant radiotherapy. In the analysis regarding the influence of chemotherapy regimens, the use of sequential anthracycline/cyclophosphamide and taxane, and concurrent 5-fluorouracil, doxorubicin and cyclophosphamide, were associated with increased risks for adverse outcomes compared with the no chemotherapy group, while the use of other regimens, including anthracycline/cyclophosphamide alone, was not.
Adjuvant chemotherapy might influence the final outcomes of two-stage implant-based reconstruction.
在即刻二期植入物乳房重建术中，若有指征，辅助化疗通常在两期手术之间进行，这可能会影响二期手术的结果。
本研究旨在评估辅助化疗对二期植入物乳房重建最终结果的潜在影响。
回顾2010年至2016年间接受即刻组织扩张器/植入物乳房重建且两期手术均完成的患者。病例分为两组——辅助化疗组和未接受辅助化疗组。比较两组不良结局的发生率。
共分析了568例患者的602例病例，平均随访期为58.5个月，其中236例患者接受辅助化疗，366例患者未接受辅助化疗。除前一组辅助放疗率显著较高外，两组基线特征相似。在调整包括辅助放疗在内的其他变量后，辅助化疗组的总体并发症发生率显著更高（优势比[OR]2.127，95%置信区间[CI]1.231 - 3.676），包括感染（OR 4.239，95% CI 1.059 - 16.970）、严重包膜挛缩（OR 2.107，95% CI 1.067 - 4.159）和重建失败（OR 12.754，95% CI 1.587 - 102.481）。在关于化疗方案影响的分析中，与未化疗组相比，序贯使用蒽环类/环磷酰胺和紫杉烷以及同时使用5-氟尿嘧啶、阿霉素和环磷酰胺与不良结局风险增加相关，而单独使用其他方案（包括单独使用蒽环类/环磷酰胺）则不然。
辅助化疗可能会影响二期植入物乳房重建的最终结果。
