辅助放疗对一期和二期假体乳房重建及自体重建的影响：18 家 Senonetwork 乳腺中心的意大利多中心研究。
The Effect of Adjuvant Radiotherapy on One- and Two-Stage Prosthetic Breast Reconstruction and on Autologous Reconstruction: A Multicenter Italian Study among 18 Senonetwork Breast Centres.
机构信息
Reconstructive and Aesthetic Plastic Surgery School, Department of Medical Biotechnology and Translational Medicine BIOMETRA-Plastic Surgery Unit, University of Milan, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
Department of Plastic Surgery, Director of the Residency Program of Plastic Surgery, IRCCS Policlinico Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
出版信息
Breast J. 2023 May 9;2023:6688466. doi: 10.1155/2023/6688466. eCollection 2023.
PURPOSE
In modern breast cancer treatment, a growing role has been observed for breast reconstruction together with an increase in clinical indications for postmastectomy radiotherapy (PMRT). Choosing the optimum type of reconstructive technique is a clinical challenge. We therefore conducted a national multicenter study to analyze the impact of PMRT on breast reconstruction.
METHODS
We conducted a retrospective case-control multicenter study on women undergoing breast reconstruction. Data were collected from 18 Italian Breast Centres and stored in a cumulative database which included the following: autologous reconstruction, direct-to-implant (DTI), and tissue expander/immediate (TE/I). For all patients, we described complications and surgical endpoints to complications such as reconstruction failure, explant, change in type of reconstruction, and reintervention.
RESULTS
From 2001 to April 2020, 3116 patients were evaluated. The risk for any complication was significantly increased in patients receiving PMRT (aOR, 1.73; 95% CI, 1.33-2.24; < 0.001). PMRT was associated with a significant increase in the risk of capsular contracture in the DTI and TE/I groups (aOR, 2.24; 95% CI, 1.57-3.20; < 0.001). Comparing type of procedures, the risk of failure (aOR, 1.82; 95% CI, 1.06-3.12, =0.030), explant (aOR, 3.34; 95% CI, 3.85-7.83, < 0.001), and severe complications (aOR, 2.54; 95% CI, 1.88-3.43, < 0.001) were significantly higher in the group undergoing DTI reconstruction as compared to TE/I reconstruction.
CONCLUSION
Our study confirms that autologous reconstruction is the procedure least impacted by PMRT, while DTI appears to be the most impacted by PMRT, when compared with TE/I which shows a lower rate of explant and reconstruction failure. The trial is registered with NCT04783818, and the date of registration is 1 March, 2021, retrospectively registered.
目的
在现代乳腺癌治疗中，乳房重建的作用越来越大，同时保乳术后放疗（PMRT）的临床适应证也在增加。选择最佳的重建技术类型是一个临床挑战。因此，我们进行了一项全国多中心研究，分析 PMRT 对乳房重建的影响。
方法
我们对接受乳房重建的女性进行了回顾性病例对照多中心研究。数据来自意大利 18 个乳房中心，存储在一个累积数据库中，包括以下内容：自体重建、直接植入（DTI）和组织扩张器/即刻（TE/I）。对于所有患者，我们描述了并发症和手术终点，如重建失败、假体取出、重建类型改变和再次干预等并发症。
结果
2001 年至 2020 年 4 月，共评估了 3116 例患者。接受 PMRT 的患者发生任何并发症的风险显著增加（优势比，1.73；95%可信区间，1.33-2.24；<0.001）。PMRT 与 DTI 和 TE/I 组包膜挛缩风险显著增加相关（优势比，2.24；95%可信区间，1.57-3.20；<0.001）。比较手术类型，失败风险（优势比，1.82；95%可信区间，1.06-3.12，=0.030）、假体取出（优势比，3.34；95%可信区间，3.85-7.83，<0.001）和严重并发症（优势比，2.54；95%可信区间，1.88-3.43，<0.001）在 DTI 重建组显著高于 TE/I 重建组。
结论
我们的研究证实，与 PMRT 相比，自体重建受影响最小，而 DTI 似乎受 PMRT 影响最大，TE/I 则表现出较低的假体取出和重建失败率。该试验在 NCT04783818 注册，注册日期为 2021 年 3 月 1 日，为回顾性注册。
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