Lee Sea-Won, Kim Yeong Ji, Song Jae Won, Yu Mina, Rhu Jiyoung, Paik Pill Sun, Kim Yong Hyuk, Lee Yun Hee
Department of Radiation Oncology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea.
Department of Radiation Oncology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 14647, Republic of Korea.
J Clin Med. 2024 Dec 31;14(1):184. doi: 10.3390/jcm14010184.
: Few studies have analyzed surgical site infections associated with hypofractionated RT. The purpose of this study was to identify risk factors for surgical site infections with a particular focus on volumetric parameters that reflect the size of the volumes treated, including tumors, surgical cavities, and breasts. : A total of 145 early breast cancer patients who were surgically staged 0-II undergoing hypofractionated RT on the whole breast were retrospectively reviewed. Tumor size (cm) was measured from surgical pathology. Surgical cavity volume (cc) and breast volume (cc) were calculated by segmenting each axial slice of simulation CT. The cavity-to-breast ratio (%) was calculated as surgical cavity volume/breast volume × 100. : The incidence of surgical site infection was 4.8% at a median of 6.3 months after the completion of RT. In univariate analysis, tumor size (OR 2.01, = 0.025), surgical cavity volume (OR 1.03, = 0.013), cavity-to-breast ratio (OR 1.29, = 0.005), and BMI (OR 1.23, = 0.014) were significantly associated with surgical site infection. In multivariate analysis, the cavity-to-breast ratio (OR 1.24, = 0.039) remained significantly associated with surgical site infection. : This study highlights the importance of volumetric parameters, specifically the cavity-to-breast ratio, as significant predictors of surgical site infection in a pure cohort of early breast cancer patients undergoing breast-conserving surgery and hypofractionated RT. Tailored approaches, including the use of prophylactic antibiotics, prophylactic aspiration, and close follow-up, may reduce the morbidity associated with surgical site infection and prevent the potential compromise of tumor outcomes.
很少有研究分析与大分割放疗相关的手术部位感染。本研究的目的是确定手术部位感染的危险因素，特别关注反映所治疗体积大小的容积参数，包括肿瘤、手术腔隙和乳房。
对总共145例接受全乳大分割放疗的0-II期手术分期的早期乳腺癌患者进行了回顾性研究。肿瘤大小（厘米）通过手术病理测量。手术腔隙体积（立方厘米）和乳房体积（立方厘米）通过对模拟CT的每个轴位切片进行分割来计算。腔隙与乳房的比例（%）计算为手术腔隙体积/乳房体积×100。
放疗完成后中位6.3个月时手术部位感染的发生率为4.8%。在单因素分析中，肿瘤大小（OR 2.01，P = 0.025）、手术腔隙体积（OR 1.03，P = 0.013）、腔隙与乳房的比例（OR 1.29，P = 0.005）和体重指数（OR 1.23，P = 0.014）与手术部位感染显著相关。在多因素分析中，腔隙与乳房的比例（OR 1.24，P = 0.039）仍然与手术部位感染显著相关。
本研究强调了容积参数，特别是腔隙与乳房的比例，作为接受保乳手术和大分割放疗的早期乳腺癌单纯队列中手术部位感染的重要预测指标的重要性。包括使用预防性抗生素、预防性抽吸和密切随访在内的针对性方法，可能会降低与手术部位感染相关的发病率，并防止肿瘤治疗结果受到潜在影响。
