Emory University School of Medicine, Atlanta, GA, USA.
Winship Cancer Institute of Emory University, Atlanta, GA, USA.
Aesthet Surg J. 2022 Apr 12;42(5):NP297-NP311. doi: 10.1093/asj/sjab415.
The literature examining decision-making related to treatment and reconstruction for women with breast cancer has established that patient, clinical, and facility factors all play a role.
The aim of this study was to use the National Cancer Database to determine how patient, clinical, and facility factors influence: (1) the receipt of immediate breast reconstruction; and (2) the type of immediate breast reconstruction received (implant-based, autologous, or a combination).
A total of 638,772 female patients with breast cancers (Tis-T3, N0-N1, or M0) who between 2004 and 2017 received immediate reconstruction following mastectomy were identified in the National Cancer Database. Univariate and multivariate logistic regression models were applied to identify characteristics associated with immediate breast reconstruction and type of reconstruction.
Immediate breast reconstruction was more frequently associated with patients of White race, younger age, with private insurance, with lesser comorbidities, who resided in zip codes with higher median incomes or higher rates of high-school graduation, in urban areas, with Tis to T2 disease, or with involvement of <4 lymph nodes (all odds ratios [ORs] > 1.1). Negative predictors of immediate breast reconstruction were insurance status with Medicaid, Medicare, other government insurance, and none or unknown insurance (all ORs < 0.79). Implant-based reconstruction was associated with non-Black race, uninsured status, completion of higher education, undifferentiated disease, and stage T0 disease (all ORs > 1.10).
These findings confirm some previous studies on what patient, clinical, and facility factors affect decision-making, but also raise new questions that relate to the impact of third-party payer on receipt and type of reconstruction postmastectomy for breast cancer.
研究乳腺癌患者治疗和重建决策的文献已经确定，患者、临床和医疗机构因素都发挥了作用。
本研究旨在利用国家癌症数据库，确定患者、临床和医疗机构因素如何影响：（1）接受即刻乳房重建；（2）接受的即刻乳房重建类型（基于植入物、自体或两者结合）。
共纳入 638772 例 2004 年至 2017 年间接受乳房切除术即刻重建的 Tis-T3、N0-N1 或 M0 期女性乳腺癌患者。在国家癌症数据库中，采用单变量和多变量逻辑回归模型确定与即刻乳房重建和重建类型相关的特征。
即刻乳房重建更常见于白人、年龄较小、有私人保险、合并症较少、居住在中位收入较高或高中以上毕业率较高的邮政编码、城市地区、Tis 至 T2 期疾病或涉及<4 个淋巴结的患者（所有比值比[OR] > 1.1）。即刻乳房重建的负预测因素是 Medicaid、Medicare、其他政府保险和无保险或未知保险（所有 OR < 0.79）。基于植入物的重建与非黑人种族、无保险状态、完成高等教育、未分化疾病和 T0 期疾病相关（所有 OR > 1.10）。
这些发现证实了之前一些关于哪些患者、临床和医疗机构因素影响决策的研究，但也提出了一些新的问题，涉及第三方付款人对乳腺癌乳房切除术后即刻重建的接受和类型的影响。
