Karadsheh Murad J, Katsnelson Jacob Y, Ruth Karen J, Weiss Eric S, Krupp James C, Sigurdson Elin R, Bleicher Richard J, Ng Marilyn, Shafqat M Shuja, Patel Sameer A
Department of Surgery, Einstein Healthcare Network, Philadelphia, Pa.
Department of Surgery, Abington-Jefferson Health, Abington, Pa.
Plast Reconstr Surg Glob Open. 2021 Apr 15;9(4):e3528. doi: 10.1097/GOX.0000000000003528. eCollection 2021 Apr.
Survival for women diagnosed with inflammatory breast cancer (IBC) has improved with advances in multimodal therapy. This study was performed to evaluate trends, predictors, and survival for reconstruction in IBC patients in the United States.
Women who underwent mastectomy with or without reconstruction for IBC between 2004 and 2016 were included from the National Cancer Database. Predictors for undergoing reconstruction and association with overall survival were determined.
Of 12,544 patients with IBC who underwent mastectomy, 1307 underwent reconstruction. Predictors of reconstruction included younger age, private insurance, higher income, performance of contralateral prophylactic mastectomy, and location within a metropolitan area ( < 0.001). The proportion of women having reconstruction for IBC increased from 7.3% to 12.3% from 2004 to 2016. Median unadjusted overall survival was higher in the reconstructive group l [93.7 months, 95% confidence interval (CI) 75.2-117.5] than the nonreconstructive group (68.1 months, 95% CI 65.5-71.7, hazard ratio = 0.79 95% CI 0.72-0.88, < 0.001). With adjustment for covariates, differences in overall mortality were not significant, with hazard ratio of 0.95 (95% CI 0.85-1.06, = 0.37).
Reconstruction rates for IBC are increasing. Women with IBC who undergo reconstruction tend to be younger and are not at the increased risk of all-cause mortality compared to those not having reconstruction. The National Cancer Database does not differentiate immediate from delayed reconstruction. However, the outcomes of immediate reconstruction in carefully selected patients with IBC should be further studied to evaluate its safety. This could impact current guidelines, which are based largely on an expert opinion.
随着多模式治疗的进展，被诊断为炎性乳腺癌（IBC）的女性的生存率有所提高。本研究旨在评估美国IBC患者重建手术的趋势、预测因素和生存率。
从国家癌症数据库中纳入2004年至2016年间因IBC接受乳房切除术（无论是否进行重建）的女性。确定了进行重建手术的预测因素及其与总生存率的关联。
在12544例接受乳房切除术的IBC患者中，1307例进行了重建手术。重建手术的预测因素包括年龄较小、拥有私人保险、收入较高、对侧预防性乳房切除术、位于大都市地区（P<0.001）。2004年至2016年间，IBC患者进行重建手术的比例从7.3%增至12.3%。重建组未调整的总生存期中位数较高[93.7个月，95%置信区间（CI）75.2-117.5]，高于未重建组（68.1个月，95%CI 65.5-71.7，风险比=0.79，95%CI 0.72-0.88，P<0.001）。在对协变量进行调整后，总死亡率差异不显著，风险比为0.95（95%CI 0.85-1.06，P=0.37）。
IBC的重建率正在上升。与未进行重建手术的IBC患者相比，进行重建手术的患者往往更年轻，且全因死亡率风险并未增加。国家癌症数据库并未区分即刻重建和延迟重建。然而，对于精心挑选的IBC患者，即刻重建的结果应进一步研究以评估其安全性。这可能会影响目前主要基于专家意见的指南。
