Zhu Jingjin, Min Ningning, Zhang Yanjun, Wu Huan, Hong Chenyan, Geng Rui, Wei Yufan, Guan Qingyu, Zheng Yiqiong, Li Xiru
School of Medicine, Nankai University, Tianjin, China.
Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China.
Gland Surg. 2023 Dec 26;12(12):1668-1685. doi: 10.21037/gs-23-384. Epub 2023 Dec 22.
Due to differences in socioeconomic and cultural backgrounds, the characteristics and prognosis of Asian female patients choosing contralateral prophylactic mastectomy (CPM) are likely to be different from Western patients. To fill the research gap of CPM in Asian populations, this study aims to explore the application trend, survival benefits, decision-making factors, and satisfaction of CPM based on the Chinese patients undergoing CPM.
The 0-III stage unilateral breast cancer (UBC) patients who received breast surgery in the Chinese PLA General Hospital from 2005 to 2017 were selected. The surgical procedures included simple mastectomy (SM), nipple-sparing mastectomy (NSM), breast conserving surgery (BCS), and CPM. Cox proportional regression analyses and Kaplan-Meier (KM) curve were performed to compare the overall survival (OS) and disease-free survival (DFS) rates between CPM group and unilateral mastectomy (UM) group. Proportional propensity score matching (PSM) with a 1:1 ratio was used to match the two groups and secondary survival analysis was performed. Logistic regression models were used to test predictive factors related to patients' CPM surgical decision-making.
Four thousand two hundred and seventy-six patients were included in the study, with 73 patients receiving CPM, 3,567 receiving SM, 151 receiving NSM, and 485 receiving BCS. CPM surgery was first used in 2007, with a peak application rate of 3.02% in 2016. Three thousand seven hundred and ninety-one patients were included in the survival analysis, with a median follow-up time of 66.60 months. Compared to UM patients, neither the KM survival curve nor Cox regression hazard analyses of CPM showed better OS (P=0.963; P=0.834). After PSM, CPM also did not exhibit significant survival benefits in OS (P=0.335) and DFS (P=0.409). The logistic regression analyses showed that NSM surgery and lower tumor-node-metastasis (TNM) stage were independent factors to promote the CPM decision-making of patients. The CPM group showed high overall satisfaction (84.9%) and relatively low appearance satisfaction (69.9%).
CPM was practiced for the first time since 2007 in our hospital. CPM does not provide any OS and DFS benefits compared to UM and the appearance satisfaction procedure was relatively low. Therefore, clinicians should fully communicate with patients before surgery and be more cautious in giving CPM recommendations.
由于社会经济和文化背景的差异，选择对侧预防性乳房切除术（CPM）的亚洲女性患者的特征和预后可能与西方患者不同。为填补亚洲人群中CPM的研究空白，本研究旨在基于接受CPM的中国患者探讨CPM的应用趋势、生存获益、决策因素及满意度。
选取2005年至2017年在中国人民解放军总医院接受乳房手术的0-III期单侧乳腺癌（UBC）患者。手术方式包括单纯乳房切除术（SM）、保乳乳头切除术（NSM）、保乳手术（BCS）和CPM。进行Cox比例回归分析和Kaplan-Meier（KM）曲线分析，以比较CPM组和单侧乳房切除术（UM）组的总生存率（OS）和无病生存率（DFS）。采用1:1比例的比例倾向评分匹配（PSM）对两组进行匹配，并进行二次生存分析。使用逻辑回归模型检验与患者CPM手术决策相关的预测因素。
本研究共纳入4276例患者，其中73例接受CPM，3567例接受SM，151例接受NSM，485例接受BCS。CPM手术于2007年首次使用，2016年应用率达到峰值3.02%。3791例患者纳入生存分析，中位随访时间为66.60个月。与UM患者相比，CPM的KM生存曲线和Cox回归风险分析均未显示出更好的OS（P=0.963；P=0.834）。PSM后，CPM在OS（P=0.335）和DFS（P=0.409）方面也未显示出显著的生存获益。逻辑回归分析显示，NSM手术和较低的肿瘤-淋巴结-转移（TNM）分期是促进患者CPM决策的独立因素。CPM组总体满意度较高（84.9%），外观满意度相对较低（69.9%）。
我院自（此处原文缺失相关时间词，推测为2007年）首次开展CPM。与UM相比，CPM未提供任何OS和DFS获益，外观满意度相对较低。因此，临床医生在手术前应与患者充分沟通，在给出CPM建议时应更加谨慎。
