Department of Surgery, University of Michigan, Ann Arbor.
Department of Surgery, Section of Plastic and Reconstructive Surgery, University of Michigan Health System, Ann Arbor.
JAMA Surg. 2021 Sep 1;156(9):847-855. doi: 10.1001/jamasurg.2021.2239.
Women undergoing immediate breast reconstruction often require chemotherapy. The effects of chemotherapy on reconstruction are not well described.
To evaluate the association of neoadjuvant and adjuvant chemotherapy with complications and patient-reported outcomes (PROs) in immediate reconstruction.
DESIGN, SETTING, AND PARTICIPANTS: The Mastectomy Reconstruction Outcomes Consortium Study is a cohort study that prospectively assessed PROs and retrospectively evaluated complications in patients undergoing immediate implant-based or autologous reconstruction at 11 centers from January 1, 2012, to December 31, 2017. Women 18 years or older undergoing immediate reconstruction after mastectomy with 2 years of follow-up were included. Patients were excluded if they had prophylactic mastectomy; delayed reconstruction; mixed-timing reconstruction; mixed reconstruction; a latissimus dorsi, superior gluteal artery perforator, or inferior gluteal artery perforator flap; or both neoadjuvant and adjuvant chemotherapy. Data were analyzed from May 1 to June 30, 2018.
Complications and PROs (satisfaction with breast and physical, psychosocial, and sexual well-being) using the BREAST-Q questionnaire, a validated, condition-specific PRO measure. Baseline patient characteristics were collected.
A total of 1881 women were included in the analysis (mean [SD] age, 49.9 [9.9] years). Of these, 1373 (73.0%) underwent implant-based procedures; 508 (27.0%), autologous reconstruction; 200 (10.6%), neoadjuvant chemotherapy; 668 (35.5%), adjuvant chemotherapy; and 1013 (53.9%), no chemotherapy. Patients without chemotherapy were significantly older (mean [SD] age, 51.6 [9.4] years; P < .001), and patients with chemotherapy were more likely to have received radiotherapy (108 of 200 [54.0%] for neoadjuvant chemotherapy and 321 of 668 [48.1%] for adjuvant chemotherapy; P < .001). Among the cohort undergoing implant-based reconstruction, the rates of any complication were significantly different, with higher rates seen for adjuvant (153 of 490 [31.2%]) and neoadjuvant (44 of 153 [28.8%]) chemotherapy compared with no chemotherapy (176 of 730 [24.1%]; P = .02). On multivariable analysis, these differences were not statistically significant. For autologous reconstruction, no significant differences in complications were observed. Controlling for clinical covariates, no significant differences were seen across chemotherapy groups for the BREAST-Q subscales except for sexual well-being in the implant cohort, in which adjuvant chemotherapy had significantly lower scores (β, -4.97 [95% CI, -8.68 to -1.27]; P = .009).
In this cohort study, neither neoadjuvant nor adjuvant chemotherapy was associated with the likelihood of complications in patients undergoing implant-based or autologous reconstruction, and chemotherapy was not associated with patient satisfaction with reconstruction or psychosocial well-being. This information can help patients and clinicians make informed decisions about breast reconstruction in the setting of chemotherapy.
接受即刻乳房重建的女性通常需要接受化疗。化疗对重建的影响尚未得到充分描述。
评估新辅助化疗和辅助化疗与即刻重建中并发症和患者报告的结局（PROs）的关系。
设计、地点和参与者：乳房切除术重建结局研究联盟是一项前瞻性评估 PROs 和回顾性评估 11 个中心 18 岁或以上接受即刻乳房切除术和即刻即刻重建后 2 年随访的患者并发症的队列研究。如果患者接受预防性乳房切除术、延迟重建、混合时机重建、混合重建、背阔肌、臀上动脉穿支或臀下动脉穿支皮瓣或新辅助和辅助化疗，则排除患者。数据于 2018 年 5 月 1 日至 6 月 30 日进行分析。
使用 BREAST-Q 问卷评估并发症和 PROs（对乳房和身体、心理社会和性功能的满意度），这是一种经过验证的、特定于疾病的 PRO 测量方法。收集基线患者特征。
共纳入 1881 例患者（平均[标准差]年龄 49.9[9.9]岁）。其中，1373 例（73.0%）接受了植入物手术；508 例（27.0%）接受了自体重建；200 例（10.6%）接受了新辅助化疗；668 例（35.5%）接受了辅助化疗；1013 例（53.9%）未接受化疗。未接受化疗的患者年龄明显较大（平均[标准差]年龄 51.6[9.4]岁；P<.001），接受化疗的患者更有可能接受放疗（新辅助化疗 200 例中有 108 例[54.0%]，辅助化疗 668 例中有 321 例[48.1%]；P<.001）。在接受植入物重建的队列中，任何并发症的发生率存在显著差异，辅助化疗（490 例中的 153 例[31.2%]）和新辅助化疗（153 例中的 44 例[28.8%]）的发生率明显高于无化疗（730 例中的 176 例[24.1%]；P=.02）。多变量分析后，这些差异无统计学意义。对于自体重建，未观察到并发症存在显著差异。控制临床协变量后，除了植入物队列的性健康外，在接受化疗的各组之间，BREAST-Q 亚量表没有显著差异，其中辅助化疗的评分显著较低（β，-4.97[95%CI，-8.68 至-1.27]；P=.009）。
在这项队列研究中，新辅助化疗和辅助化疗均与接受植入物或自体重建的患者发生并发症的可能性无关，且化疗与患者对重建或心理社会健康的满意度无关。这些信息可以帮助患者和临床医生在化疗环境下对乳房重建做出明智的决策。
