Foley Angela, Choppa Adrian, Bhimani Fardeen, Gundala Thoran, Shamamian Meredith, LaFontaine Samantha, Tran David, Johnson Kelly, Weichman Katie, Feldman Sheldon, McEvoy Maureen P
Albert Einstein College of Medicine, Bronx, NY, USA.
Breast Surgery Division, Department of Surgery, Montefiore Medical Center, Montefiore Einstein Comprehensive Cancer Center, Bronx, NY, USA.
Gland Surg. 2024 Mar 27;13(3):358-373. doi: 10.21037/gs-23-403. Epub 2024 Mar 20.
Oncoplastic breast-conserving surgery (OBCS) has demonstrated superior cosmetic outcomes to traditional breast-conserving surgery (BCS) while maintaining oncologic safety. While prior studies have compared OBCS to mastectomy, there is a scarcity of literature on the impact of social determinants of health on outcomes. Furthermore, although traditionally tumors larger than 5 cm and multifocal disease were treated with mastectomy, the literature has now shown OBCS to be safe in treating such disease. As a result, patients with large or multifocal tumors could be eligible for both mastectomy and OBCS, which prompts the need for comparison between the two. Thus, the aim of our study was to compare OBCS and mastectomy with reconstruction using BREAST-Q and oncologic outcome measures, as well as stratify these outcomes based on race, ethnicity, and body mass index (BMI).
A retrospective chart review was performed for 57 patients treated with OBCS and 204 patients treated with mastectomy with reconstruction from 2015 to 2021. Variables including age, race, ethnicity, BMI, insurance status, surgery type, pathology, recurrence, and complications were recorded. Patient-reported outcomes (PROs) were recorded using BREAST-Q pre- and post-operatively.
Despite having a higher BMI (P<0.001), OBCS yielded higher "satisfaction with breast" and "satisfaction with outcome" than mastectomy (P=0.02 and P=0.02, respectively). When stratified by race, there were no statistical differences in the PROs between the two surgeries for Hispanic nor African American patients. OBCS had a significantly lower rate of infection and fewer additional surgeries than mastectomy (P=0.004 and P<0.001, respectively). There were no differences in positive margin rate or recurrence rate between the groups.
In our study, OBCS yielded better PROs than mastectomy while maintaining oncologic safety and resulting in fewer surgeries and complications. These excellent outcomes in a majority non-Caucasian cohort support the utilization of OBCS for underserved, minority populations. Larger studies evaluating PROs in diverse and uninsured groups are needed to reinforce these conclusions.
肿瘤整形保乳手术（OBCS）已证明与传统保乳手术（BCS）相比，在保持肿瘤学安全性的同时具有更好的美容效果。虽然先前的研究已将OBCS与乳房切除术进行了比较，但关于健康的社会决定因素对手术结果影响的文献却很匮乏。此外，尽管传统上大于5厘米的肿瘤和多灶性疾病采用乳房切除术治疗，但现在文献表明OBCS治疗此类疾病是安全的。因此，患有大肿瘤或多灶性肿瘤的患者可能适合乳房切除术和OBCS两种手术，这就促使需要对两者进行比较。因此，我们研究的目的是使用BREAST-Q和肿瘤学结果指标比较OBCS和乳房切除术后重建手术，并根据种族、民族和体重指数（BMI）对这些结果进行分层。
对2015年至2021年期间接受OBCS治疗的57例患者和接受乳房切除术后重建手术的204例患者进行回顾性病历审查。记录包括年龄、种族、民族、BMI、保险状况、手术类型、病理、复发和并发症等变量。术前和术后使用BREAST-Q记录患者报告的结果（PROs）。
尽管OBCS组的BMI较高（P<0.001），但其“对乳房的满意度”和“对结果的满意度”均高于乳房切除术（分别为P=0.02和P=0.02）。按种族分层时，西班牙裔和非裔美国患者的两种手术的PROs之间无统计学差异。OBCS的感染率明显低于乳房切除术，且额外手术较少（分别为P=0.004和P<0.001）。两组之间的切缘阳性率或复发率无差异。
在我们的研究中，OBCS在保持肿瘤学安全性的同时，产生了比乳房切除术更好的PROs，且手术和并发症更少。在大多数非白种人队列中的这些优异结果支持了对服务不足的少数族裔人群使用OBCS。需要更大规模的研究来评估不同和未参保群体中的PROs，以强化这些结论。
