Notenboom M C A W, Klem T M A L, Contant C M E, Ribbe S P, Franckena M, Penninkhof J J, Koppert L B, Plaisier P W, Mureau M A M, van Werkhoven E D, van der Veen F J C, de Kraker M, Nout R A, Menke-Pluijmers M B E, Froklage F E
Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, the Netherlands; Department of Surgery, Albert Schweitzer Hospital, Dordrecht, the Netherlands.
Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands.
Breast. 2025 Jul 14;83:104541. doi: 10.1016/j.breast.2025.104541.
Breast fibrosis is a well-known late side-effect of breast-conserving therapy (BCT) and may lead to breast retraction, asymmetry, and pain. Since life expectancy of breast cancer patients has significantly improved in the past decades, cosmetic outcomes and health-related quality of life (HRQoL) have gained importance. This study aimed to investigate the association between breast fibrosis, cosmetic outcomes, and various HRQoL domains.
In this multicenter, cross-sectional, observational cohort (STARLINGS study), breast fibrosis was assessed (CTCAE version 5), breast photos were analyzed with BCCT.core software, and participants completed BREAST-Q, EORTC QLQ-BR23/C30, and 9-item cosmetic questionnaire. Associations between breast fibrosis and HRQoL and between cosmetic outcomes and HRQoL, were analyzed using multivariable linear regression, both unadjusted and adjusted for age, smoking and body mass index.
A total of 775 patients treated between 2016 and 2020 were included, with median follow-up of 4 years. Compared to patients with moderate/severe breast fibrosis, patients with none/mild breast fibrosis reported better HRQoL on all domains, except Sexual Functioning, Sexual Enjoyment, and Physical and Social Functioning. Patients with excellent/good cosmetic outcomes reported better HRQoL than patients with fair/poor cosmetic outcomes on five out of 18 HRQoL domains, but not on any of the Symptoms domains.
Our results indicate that breast fibrosis and unfavorable cosmetic outcomes are negatively associated with various HRQoL domains. Additionally, breast fibrosis is associated with locoregional symptoms and fatigue, whereas unfavorable cosmetic outcomes are not. This large multicenter study corroborates the interrelated nature of breast fibrosis, cosmetic outcomes, and HRQoL (ID: NCT05263362).
乳腺纤维化是保乳治疗（BCT）一种众所周知的晚期副作用，可能导致乳房回缩、不对称和疼痛。在过去几十年中，乳腺癌患者的预期寿命显著提高，因此美容效果和健康相关生活质量（HRQoL）变得越发重要。本研究旨在调查乳腺纤维化、美容效果与HRQoL各领域之间的关联。
在这项多中心、横断面、观察性队列研究（STARLINGS研究）中，对乳腺纤维化进行评估（采用美国国立癌症研究所不良事件通用术语标准第5版），使用BCCT.core软件分析乳房照片，参与者完成BREAST-Q、欧洲癌症研究与治疗组织QLQ-BR23/C30问卷以及9项美容调查问卷。采用多变量线性回归分析乳腺纤维化与HRQoL之间以及美容效果与HRQoL之间的关联，分析时既未进行调整，也对年龄、吸烟和体重指数进行了调整。
共纳入了2016年至2020年间接受治疗的775例患者，中位随访时间为4年。与中度/重度乳腺纤维化患者相比，无/轻度乳腺纤维化患者在所有领域的HRQoL表现更好，但性功能、性快感以及身体和社会功能领域除外。美容效果为优/良的患者在18个HRQoL领域中的5个领域的HRQoL表现优于美容效果为中/差的患者，但在任何症状领域均未出现这种情况。
我们的结果表明，乳腺纤维化和不良美容效果与HRQoL的各个领域呈负相关。此外，乳腺纤维化与局部区域症状和疲劳相关，而不良美容效果则不然。这项大型多中心研究证实了乳腺纤维化、美容效果和HRQoL之间的相互关系（标识符：NCT05263362）。
