乳房切除术（重建与不重建）后的后悔和生活质量。
Regret and Quality of Life After Mastectomy With or Without Reconstruction.
机构信息
Breast Center, Department of Surgery, San Giovanni-Addolorata Hospital Rome, Rome, Italy.
Department of Statistical Sciences, University of Padova, Padova, Italy.
出版信息
Clin Breast Cancer. 2021 Jun;21(3):162-169. doi: 10.1016/j.clbc.2019.11.005. Epub 2020 Oct 14.
BACKGROUND
Mastectomy represents a deep burden for women with breast cancer. Very little is known about the psychological consequences over time and the quality of life (QoL) of women so treated, with or without breast reconstruction (BR).
PATIENTS AND METHODS
A total of 709 patients underwent mastectomy with or without BR between 2002 and 2012 at one institution. Among 468 surviving patients, a 60-query QoL questionnaire on personal issues including some European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire items was presented either by email, letter, or telephone interview.
RESULTS
Of those questioned, 328 patients participated, whereas 140 (30%) declined the invitation or were unavailable. The median age was 63 years (range, 30-93 years). Stage I or II of disease was recorded in 73% of patients. Immediate BR was performed in 168 (51%) of 328 patients. Of the remaining patients, only 7 (4%) of 160 proceeded to delayed BR. Younger women had significantly worse Emotional Functioning and Social Functioning (SF) scores (P < .001), independently of tumor stage, and immediate BR improved that (P = .02). SF score was also worsened by chemotherapy (P = .03). Cognitive Functioning score was independent of age, BR, stage, or adjuvant therapies. Body Image and Sexual Functioning scores improved with BR (P < .03), and age was a strong co-variable (P < .001). On multivariate analysis, immediate BR was correlated with age and preoperative plastic surgery consultation. Some 68 (21%) of 328 patients regretted their decision or were disappointed with their choice regarding BR.
CONCLUSIONS
Younger patients with breast cancer report a worse impact on their Emotional Functioning and SF scores after mastectomy, both of which are improved by BR. Reconstructing the breast at the time of mastectomy has a significant impact on Body Image and Sexual Functioning scores. A preoperative plastic surgeon consultation improves the rate of immediate BR, whereas delayed reconstruction is rarely adopted. Some 20% of patients are disappointed in or regret their decision regarding BR. We need to improve our management in consideration of these findings.
背景
乳腺癌患者行乳房切除术是一个沉重的打击。目前，人们对接受乳房切除术的女性患者的心理后果以及其生活质量（QoL）知之甚少，尤其是在没有进行乳房重建（BR）的情况下。
方法
本研究共纳入了 2002 年至 2012 年期间在一家医院接受乳房切除术且接受或未接受 BR 的 709 例患者。在 468 例生存患者中，通过电子邮件、信件或电话访谈的方式向其发放了一份包含 60 个问题的 QoL 问卷，问题涉及个人问题，包括一些欧洲癌症研究和治疗组织（EORTC）的 QoL 问卷项目。
结果
在接受调查的患者中，有 328 例患者参与了研究，而有 140 例（30%）拒绝了邀请或无法联系。患者的中位年龄为 63 岁（范围 30-93 岁）。73%的患者为疾病 I 期或 II 期。在 328 例患者中，有 168 例行即刻 BR。其余 160 例患者中，仅有 7 例（4%）接受了延迟 BR。年轻女性的情绪功能和社会功能评分明显较差（P <.001），与肿瘤分期无关，即刻 BR 可改善这一点（P <.02）。化疗也会使社会功能评分恶化（P <.03）。认知功能评分与年龄、BR、分期或辅助治疗无关。BR 可改善体像和性功能评分（P <.03），年龄是一个重要的协变量（P <.001）。多变量分析显示，即刻 BR 与年龄和术前整形咨询有关。在 328 例患者中，有 68 例（21%）对他们的决定感到后悔或对 BR 的选择感到失望。
结论
年轻的乳腺癌患者在接受乳房切除术后，其情绪功能和社会功能评分的影响更差，BR 可改善这两项评分。在乳房切除术中进行乳房重建对体像和性功能评分有显著影响。术前与整形医生进行咨询可提高即刻 BR 的比率，而延迟重建则很少采用。约 20%的患者对 BR 的决定感到失望或后悔。我们需要考虑这些发现来改进我们的管理。
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