Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands.
Department of Surgery, St. Antonius Hospital, Utrecht, The Netherlands.
Cancer. 2022 Oct 1;128(19):3449-3469. doi: 10.1002/cncr.34393. Epub 2022 Jul 27.
Oncological safety of different types and timings of PMBR after breast cancer remains controversial. Lack of stratified risk assessment in literature makes current clinical and shared decision-making complex. This is the first systematic review and meta-analysis to evaluate differences in oncological outcomes after immediate versus delayed postmastectomy breast reconstruction (PMBR) for autologous and implant-based PMBR separately.
A systematic literature search was performed in MEDLINE, Cochrane Library, and Embase. The Cochrane Collaboration Handbook and Meta-analysis Of Observational Studies in Epidemiology checklist were followed for data abstraction. Variability in point estimates attributable to heterogeneity was assessed using I -statistic. (Loco)regional breast cancer recurrence rates, distant metastasis rates, and overall breast cancer recurrence rates were pooled in generalized linear mixed models using random effects.
Fifty-five studies, evaluating 14,217 patients, were included. When comparing immediate versus delayed autologous PMBR, weighted average proportions were: 0.03 (95% confidence interval [CI], 0.02-0.03) versus 0.02 (95% CI, 0.01-0.04), respectively, for local recurrences, 0.02 (95% CI, 0.01-0.03) versus 0.02 (95% CI, 0.01-0.03) for regional recurrences, and 0.04 (95% CI, 0.03-0.06) versus 0.01 (95% CI, 0.00-0.03) for locoregional recurrences. No statistically significant differences in weighted average proportions for local, regional and locoregional recurrence rates were observed between immediate and delayed autologous PMBR. Data did not allow comparing weighted average proportions of distant metastases and total breast cancer recurrences after autologous PMBR, and of all outcome measures after implant-based PMBR.
Delayed autologous PMBR leads to similar (loco)regional breast cancer recurrence rates compared to immediate autologous PMBR. This study highlights the paucity of strong evidence on breast cancer recurrence after specific types and timings of PMBR.
Oncologic safety of different types and timings of postmastectomy breast reconstruction (PMBR) remains controversial. Lack of stratified risk assessment in literature makes clinical and shared decision-making complex. This meta-analysis showed that delayed autologous PMBR leads to similar (loco)regional recurrence rates as immediate autologous PMBR. Data did not allow comparing weighted average proportions of distant metastases and total breast cancer recurrence after autologous PMBR, and of all outcome measures after implant-based PMBR. Based on current evidence, oncological concerns do not seem a valid reason to withhold patients from certain reconstructive timings or techniques, and patients should equally be offered all reconstructive options they technically qualify for.
不同类型和时间的保乳术后乳房重建（PMBR）的肿瘤安全性仍存在争议。文献中缺乏分层风险评估使得目前的临床和共同决策变得复杂。这是首次对自体和植入物 PMBR 分别进行即时与延迟 PMBR 的肿瘤学结局进行系统评价和荟萃分析。
在 MEDLINE、Cochrane 图书馆和 Embase 中进行系统文献检索。遵循 Cochrane 协作手册和观察性研究荟萃分析的清单进行数据提取。使用随机效应在广义线性混合模型中汇总点估计的差异归因于异质性的 I -统计量。（局部）区域乳腺癌复发率、远处转移率和总乳腺癌复发率分别为 0.03（95%置信区间 [CI]，0.02-0.03）和 0.02（95%CI，0.01-0.04）、0.02（95%CI，0.01-0.03）和 0.02（95%CI，0.01-0.03）以及 0.04（95%CI，0.03-0.06）和 0.01（95%CI，0.00-0.03）。即时与延迟自体 PMBR 之间（局部）区域复发率、（局部）区域复发率和（局部）区域复发率的加权平均比例无统计学显著差异。自体 PMBR 后远处转移和总乳腺癌复发率以及植入物 PMBR 后所有结局指标的加权平均比例的数据无法比较。
延迟自体 PMBR 与即时自体 PMBR 相比导致相似的（局部）区域乳腺癌复发率。本研究强调了文献中缺乏关于特定类型和时间的 PMBR 后乳腺癌复发的强有力证据。
不同类型和时间的保乳术后乳房重建（PMBR）的肿瘤安全性仍存在争议。文献中缺乏分层风险评估使得临床和共同决策变得复杂。这项荟萃分析表明，延迟自体 PMBR 与即时自体 PMBR 相比导致相似的（局部）区域复发率。自体 PMBR 后远处转移和总乳腺癌复发率以及植入物 PMBR 后所有结局指标的加权平均比例的数据无法比较。基于目前的证据，肿瘤学方面的担忧似乎不是拒绝患者接受某些重建时间或技术的有效理由，并且应平等地为他们提供所有技术上合格的重建选择。
