Department of Breast Oncology, H. Lee Moffitt Cancer Center, 10920 McKinley Dr, Tampa, FL, 33612, USA.
Breast Cancer Res Treat. 2021 Aug;188(3):641-648. doi: 10.1007/s10549-021-06241-4. Epub 2021 May 3.
Operative complications affect recurrence in non-breast malignancies. Rising rates of mastectomy with immediate reconstruction and their increased post-operative complications fuel concerns for poorer outcome in breast cancer (BC). We sought to determine the effect of complications on recurrence in BC patients.
A single-institution retrospective review was conducted of incident BC treated with mastectomy and immediate reconstruction. Overall survival and recurrence were compared between patients with complications to those without.
Of 201 patients (350 mastectomies, 86 nipple-sparing), 62 (30.8%) had a surgical complication. Patients with complications were older, but groups were similar for type of reconstruction, tobacco use, hormone receptor status, HER2, lymphovascular invasion, and pathologic stage (all p > 0.05). Twenty-two complications (10.9%) were infection, 5 (2.5%) dehiscence, 14 flap necrosis (7%), 21 hematomas (10.4%), and 8 nipple necroses (9%). Recurrence occurred in 18 (8.9%) patients: 4 local, 2 regional, and 12 distant. After 8.9 years of median follow-up, patients with complications trended towards higher recurrence (hazard ratio (HR) 2.23, log-rank p = 0.08, Cox regression p = 0.05), particularly with nipple necrosis (HR 3.28, log-rank p = 0.09, regression p = 0.06). Patients with other complications had similar recurrence-free survival to those without (all p > 0.05). Higher stage (HR 13.66, log-rank p = 0.03) and adjuvant radiation (HR 2.78, log-rank p = 0.04) cases were more likely to recur. Patients with complications had similar overall survival to those without (log-rank p > 0.05).
BC patients with surgical complications do not have lower overall survival. This finding may be due to the improved prognosis compared to non-breast malignancies.
手术并发症会影响非乳腺癌患者的复发率。随着即刻乳房重建的乳房切除术比例上升及其术后并发症的增加，人们对乳腺癌（BC）患者预后变差的担忧加剧。我们旨在确定并发症对 BC 患者复发的影响。
对接受乳房切除术和即刻重建的初发 BC 患者进行单机构回顾性研究。比较有并发症的患者和无并发症的患者之间的总生存率和复发率。
201 例患者（350 例乳房切除术，86 例保留乳头）中，62 例（30.8%）发生手术并发症。有并发症的患者年龄较大，但两组在重建类型、吸烟状况、激素受体状态、HER2、淋巴管血管侵犯和病理分期方面相似（均 P>0.05）。22 例并发症为感染（10.9%），5 例为切口裂开（2.5%），14 例皮瓣坏死（7%），21 例血肿（10.4%），8 例乳头坏死（9%）。18 例（8.9%）患者发生复发：4 例局部复发，2 例区域复发，12 例远处转移。中位随访 8.9 年后，有并发症的患者复发风险呈上升趋势（风险比（HR）2.23，对数秩检验 P=0.08，Cox 回归 P=0.05），尤其是乳头坏死的患者（HR 3.28，对数秩检验 P=0.09，回归 P=0.06）。有其他并发症的患者与无并发症的患者的无复发生存率相似（均 P>0.05）。较高的分期（HR 13.66，对数秩检验 P=0.03）和辅助放疗（HR 2.78，对数秩检验 P=0.04）患者更有可能复发。有并发症的患者与无并发症的患者的总生存率相似（对数秩检验 P>0.05）。
BC 患者发生手术并发症不会降低总生存率。这一发现可能是由于与非乳腺癌相比，预后有所改善。
