School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI.
Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Clin Breast Cancer. 2021 Oct;21(5):433-439. doi: 10.1016/j.clbc.2021.03.009. Epub 2021 Mar 27.
Some surgeons remain hesitant to perform immediate breast reconstruction (IBR) in patients with higher risk cancers owing to concerns about cancer recurrence and/or detection. Our objective was to determine the rate of ipsilateral local-regional recurrence for stage II/III patients who underwent IBR.
The National Cancer Database special study mechanism was used to create a stratified sample of women diagnosed with stage II/III breast cancer from 1217 facilities. Demographic, tumor, and recurrence data for women who underwent mastectomy with or without IBR were abstracted, including location of recurrence and method of detection. Estimates of 5-year local-regional recurrence rates were calculated and factors associated with recurrence were identified with multivariable Cox regression.
Some 13% (692/5318) of stage II/III patients underwent IBR after mastectomy. Patients undergoing IBR were younger (P < .001), with fewer comorbid conditions (P < .001), and with lower tumor burden in the breast (P = .001) and the lymph nodes (P = 0.01). The 5-year rate of ipsilateral local-regional recurrence was 3.6% with no significant difference between patients with or without IBR (3.0% vs. 3.7%, P = .4). Most recurrences were detected by the patient (45%) or on physician examination (24%). Reconstruction was not associated with recurrence on multivariable analysis (hazard ratio = 0.83, P = .52).
Women with stage II/III breast cancer selected for IBR had similar rates of ipsilateral local-regional recurrence compared with those undergoing mastectomy alone. Offering IBR after mastectomy in a patient-centered manner to select patients with stage II/III breast cancer is an acceptable consideration.
由于担心癌症复发和/或检测问题，一些外科医生仍然不愿为高风险癌症患者施行即刻乳房重建（IBR）。我们的目的是确定接受 IBR 的 II/III 期患者同侧局部区域复发的发生率。
利用国家癌症数据库特殊研究机制，从 1217 个设施中创建了一个分层样本，该样本包含 II/III 期乳腺癌诊断的女性。提取了接受或不接受 IBR 的乳房切除术患者的人口统计学、肿瘤和复发数据，包括复发部位和检测方法。计算了 5 年局部区域复发率的估计值，并使用多变量 Cox 回归确定与复发相关的因素。
约 13%（692/5318）的 II/III 期患者在乳房切除术后接受了 IBR。接受 IBR 的患者更年轻（P <.001），合并症较少（P <.001），乳房（P =.001）和淋巴结（P = 0.01）肿瘤负担较低。同侧局部区域复发的 5 年发生率为 3.6%，IBR 患者与无 IBR 患者之间无显著差异（3.0% vs. 3.7%，P =.4）。大多数复发是由患者（45%）或医生检查（24%）发现的。多变量分析显示，重建与复发无关（风险比=0.83，P =.52）。
选择接受 IBR 的 II/III 期乳腺癌患者的同侧局部区域复发率与仅接受乳房切除术的患者相似。以患者为中心的方式在 II/III 期乳腺癌患者中提供 IBR 是可以接受的考虑因素。
