Aix Marseille Univ, INSERM, IRD, SESSTIM, ISSPAM, Cancer Biomedicine & Society Group, Equipe Labellisée Ligue 2019, 13009, Marseille, BDR, France.
Department of Surgery, Institut Paoli-Calmettes, Marseille, France.
Breast Cancer Res Treat. 2022 Jul;194(2):449-461. doi: 10.1007/s10549-022-06626-z. Epub 2022 May 24.
Women with breast cancer (BC) who have a mastectomy may subsequently undergo breast reconstruction (BR). This study aimed to identify (1) factors associated with having BR, (2) factors associated with immediate BR (IBR) and delayed BR (DBR), and (3) associations between no BR, IBR and DBR and physical and mental quality of life (QoL) 5 years after diagnosis.
Analyses were based on data from the national French cancer cohort VICAN, which followed a representative sample of cancer survivors, including BC survivors, for 5 years after diagnosis. BR and BR type (IBR/DBR) were identified using medico-administrative databases. The SF12 scale was used to measure mental and physical QoL. Multivariate logistic regressions were used to identify factors associated with BR, and linear models to evaluate associations between BR and BR type with QoL.
Of the 1192 BC survivors in VICAN, 32.6% (n = 388) had a mastectomy. Among them, 60.1% (n = 233) had BR. Of these, 38.6% (n = 90) and 61.4% (n = 143) had IBR and DBR, respectively. Compared with women who had BR, women who did not were more likely to be older and to have a lower level of health literacy. Compared with women who did not have BR, those with IBR had better mental QoL, while those who had either IBR or DBR had better physical QoL.
Older women and those with inadequate health literacy were less likely to have BR. This may reflect women's preferences, inequalities in care options offered after a mastectomy, and socioeconomic barriers to accessing BR. These issues need further exploration. Furthermore, BR was associated with a better long-term physical QoL. IBR was associated with better mental QoL and should be promoted when possible.
接受乳房切除术的乳腺癌（BC）女性可能随后会进行乳房重建（BR）。本研究旨在确定：（1）与接受 BR 相关的因素，（2）与即刻 BR（IBR）和延迟 BR（DBR）相关的因素，以及（3）在诊断后 5 年内，未接受 BR、IBR 和 DBR 与身体和精神健康相关生活质量（QoL）之间的关系。
分析基于法国全国癌症队列 VICAN 的数据，该队列在诊断后 5 年内对包括 BC 幸存者在内的癌症幸存者进行了代表性样本的随访。使用医疗管理数据库来确定 BR 和 BR 类型（IBR/DBR）。使用 SF12 量表来衡量心理和身体 QoL。多变量逻辑回归用于确定与 BR 相关的因素，线性模型用于评估 BR 和 BR 类型与 QoL 之间的关系。
在 VICAN 中的 1192 名 BC 幸存者中，32.6%（n=388）接受了乳房切除术。其中，60.1%（n=233）接受了 BR。其中，38.6%（n=90）和 61.4%（n=143）分别接受了 IBR 和 DBR。与接受 BR 的女性相比，未接受 BR 的女性更可能年龄较大且健康素养水平较低。与未接受 BR 的女性相比，接受 IBR 的女性心理健康状况更好，而接受 IBR 或 DBR 的女性身体健康状况更好。
年龄较大和健康素养较低的女性不太可能接受 BR。这可能反映了女性的偏好、乳房切除术后提供的护理方案的不平等以及获得 BR 的社会经济障碍。这些问题需要进一步探讨。此外，BR 与长期身体 QoL 相关。IBR 与更好的心理健康相关，应在可能的情况下进行推广。
