Long-Term Survival Outcomes in Locally Advanced Breast Cancer after Mastectomy with or without Breast Reconstruction.

IF 2.5 3区医学 Q3 ONCOLOGY Oncology Pub Date : 2024-10-22 DOI:10.1159/000541771

Heng Zhang, AiJie Zhang, Tingting Wei, Hongbo Huang, Ying Huang, Ze Zhang, Yijing Xu, Lingquan Kong, Yunhai Li, Fan Li

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Abstract

Introduction: There is ongoing debate about the safety of breast reconstruction for patients with locally advanced breast cancer (LABC) who have undergone total mastectomy (TM). More and more LABC patients are undergoing breast reconstruction after TM, but its long-term survival outcomes remain unclear. This study aimed to compare the survival outcomes of LABC patients who underwent breast reconstruction after TM with those who did not, based on a large sample.

Methods: We collected data for all LABC patients who underwent TM with or without breast reconstruction in the Surveillance, Epidemiology, and End Results (SEER) database. We divided patients into two groups: TM group and total mastectomy with reconstruction (TM+R) group. The primary outcomes were overall survival (OS) and breast cancer-specific survival (BCSS). Propensity score matching (PSM) analysis was used to eliminate imbalances of baseline data between the two groups. Data were analyzed using χ2 tests, Kaplan-Meier methods, and univariate and multivariate Cox regression analyses.

Result: We identified 39,112 eligible patients (33,169 patients received TM and 5,943 received TM+R), and 8,680 patients were matched after PSM (4,340 patients received TM and 4,340 received TM+R). Patients with middle age, white, married, lived in urban, IIB-IIIA stage, invasive ductal carcinoma, pathological grade II-III, hormone receptor-positive, and undergone chemotherapy were more likely to receive breast reconstruction. After PSM, Kaplan-Meier survival analysis showed better OS and BCSS in the TM+R group versus the TM group (OS: p < 0.001; BCSS: p = 0.008). Multivariate Cox regression analysis showed that TM+R significantly improved OS and BCSS (OS: hazard ratio 0.73, 95% confidence interval [CI] [0.68, 0.79], p < 0.001; BCSS: 95% CI [0.79, 0.94], p = 0.001). Subgroup analysis showed that patients with old age, white, and hormone receptor-positive had better OS and BCSS by TM+R compared to TM.

Conclusions: Breast reconstruction after TM is associated with better OS and BCSS in patients with LABC.

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局部晚期乳腺癌乳房切除术后的长期生存结果（无论是否进行乳房重建

导言：关于接受全乳房切除术（TM）的局部晚期乳腺癌（LABC）患者乳房再造的安全性一直存在争议。越来越多的局部晚期乳腺癌患者在全乳切除术后接受乳房再造，但其长期生存结果仍不明确。本研究旨在基于大样本，比较接受全乳切除术后乳房重建的 LABC 患者与未接受全乳切除术后乳房重建的 LABC 患者的生存结果：方法：我们从监测、流行病学和最终结果（SEER）数据库中收集了所有接受或未接受乳房重建手术的 LABC 患者的数据。我们将患者分为两组：TM组和全乳房切除加重建（TM+R）组。主要结果为总生存期（OS）和乳腺癌特异性生存期（BCSS）。采用倾向得分匹配（PSM）分析来消除两组间基线数据的不平衡。数据分析采用了卡普兰-梅耶法（Kaplan-Meier）、单变量和多变量考克斯回归分析等方法：我们确定了 39,112 名符合条件的患者（33,169 名患者接受了 TM，5,943 名患者接受了 TM+R），8680 名患者经过 PSM 匹配（4,340 名患者接受了 TM，4,340 名患者接受了 TM+R）。中年、白人、已婚、居住在城市、IIB-IIIA期、浸润性导管癌（IDC）、病理分级II-III级、激素受体阳性、接受过化疗的患者更有可能接受乳房重建。PSM后，Kaplan-Meier生存分析显示，TM+R组的OS和BCSS优于TM组（OS：P<0.001；BCSS：P=0.008）。多变量 cox 回归分析显示，TM+R 能显著改善 OS 和 BCSS（OS：危险比（HR）0.73，95% CI [0.68,0.79]，P<0.001；BCSS：95% CI [0.79]，P<0.001）：95%CI[0.79,0.94]，P=0.001）。亚组分析显示，老年、白人和激素受体阳性患者与 TM 相比，TM+R 的 OS 和 BCSS 更佳：结论：全乳房切除术后乳房重建与LABC患者更好的OS和BCSS相关。

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来源期刊

Oncology 医学-肿瘤学

CiteScore

6.00

自引率

2.90%

发文量

审稿时长

6-12 weeks

期刊介绍： Although laboratory and clinical cancer research need to be closely linked, observations at the basic level often remain removed from medical applications. This journal works to accelerate the translation of experimental results into the clinic, and back again into the laboratory for further investigation. The fundamental purpose of this effort is to advance clinically-relevant knowledge of cancer, and improve the outcome of prevention, diagnosis and treatment of malignant disease. The journal publishes significant clinical studies from cancer programs around the world, along with important translational laboratory findings, mini-reviews (invited and submitted) and in-depth discussions of evolving and controversial topics in the oncology arena. A unique feature of the journal is a new section which focuses on rapid peer-review and subsequent publication of short reports of phase 1 and phase 2 clinical cancer trials, with a goal of insuring that high-quality clinical cancer research quickly enters the public domain, regardless of the trial’s ultimate conclusions regarding efficacy or toxicity.