影响乳腺癌患者选择保留乳房手术治疗的因素研究

目的 分析影响乳腺癌患者选择保留乳房手术治疗的因素。方法 回顾性分析256例乳腺癌患者的临床资料,依据手术方式分为保留乳房手术组和乳腺根治术组。收集患者一般临床资料,采用单因素及多因素Logistic分析影响乳腺癌患者选择保留乳房手术治疗的因素。结果 乳腺根治术组家庭人均可支配收入少、居住地在乡村、癌症家族史、乳腺良性疾病史、对放疗怀有恐惧、外科医生不建议保乳人数占比高于保留乳房手术组,差异有统计学意义(P<0.05);多因素Logistic回归分析显示,家庭人均可支配收入少、居住地在乡村、癌症家族史、乳腺良性疾病史、对放疗怀有恐惧、外科医生不建议保乳均是影响乳腺癌患者选择保留乳房手术的独立危险因素。结论 家庭人均可支配收入少、居住地在乡村、癌症家族史、乳腺良性疾病史、对放疗怀有恐惧、外科医生建议均是影响乳腺癌患者选择保留乳房手术的独立危险因素。     

影响男性乳腺癌预后的多因素分析——单中心72例临床资料总结

背景与目的:中国男性乳腺癌的报道大多是小样本、回顾性研究,而分析影响患者预后因素的报道极少。本研究在相对比较大样本的中国男性乳腺癌资料基础上探讨影响患者预后的因素。方法:收集1969年1月至2009年3月在中山大学肿瘤防治中心经病理确诊、随访资料齐全的72例男性乳腺癌患者的临床资料。采用Kaplan-Meier方法、log-rank检验和Cox回归模型分析影响男性乳腺癌患者预后的因素。结果:本组男性乳腺癌患者的5年总生存率为72.4%,其中Ⅰ期100%,Ⅱ期74.2%、Ⅲ期57.2%、Ⅳ期0。单因素分析显示,肿瘤大小(P<0.001)、腋窝淋巴结转移(P=0.001)、TNM分期(P=0.001)、手术方式(手术和非手术比较:P<0.001;经典根治术和改良根治术比较:P=0.336)、有无内分泌治疗(P=0.02)是影响男性乳腺癌预后的因素。Cox多因素模型分析显示,TNM分期(P=0.035)、手术与否(P=0.021)、有无内分泌治疗(P=0.019)是影响预后的主要因素。结论:TNM分期、手术与否和有无内分泌治疗是影响中国男性乳腺癌预后的重要因素,提示早期发现和以手术为主、包含有内分泌治疗的综合治疗模...     

乳腺癌患者生存与复发的随访报告：一项单中心回顾性研究

目的探讨乳腺癌患者长期的OS和无复发生存(RFS)及其影响因素。 方法依据纳入、排除标准,选取2000年1月1日至2015年12月31日在解放军总医院第五医学中心乳腺外科治疗的乳腺癌患者作为研究对象进行回顾性分析,最终共有2 423例患者纳入随访。采用Kaplan-Meier法及Log-rank检验比较不同临床分期、不同分子分型以及不同手术方式的患者5年OS和RFS的差异。采用Cox比例风险回归模型分析患者生存的影响因素。 结果2 423例乳腺癌患者的中位年龄为48岁,随访时间为3.5～18.7年,中位随访时间为5.2年,随访率为85.3%(2 066/2 423)。本组患者5年、10年OS率分别为91.5%和84.4%,5年、10年RFS率(除外Ⅳ期乳腺癌)分别为85.8%和78.4%。在临床分期方面：本组可手术乳腺癌患者占81.0%(1 963/2 423),局部晚期乳腺癌患者占15.6%(378/2 423),Ⅳ期患者占3.4%(82/2 423)。0、Ⅰ、Ⅱ、Ⅲ、Ⅳ期患者5年OS率分别为100%、98.5%、93.8%、78.1%和50.8%,5年RFS率(除外Ⅳ期乳腺癌)分别为98.5%、95.4%、87.0%和63.0%。临床分期与患者5年OS及RFS明显关联(χ²＝356.067、250.433,P均<0.001)。在分子分型方面：排除205例分子分型不详者后,将剩余2 218例按照受体状况分为luminal型、HER-2过表达型和三阴性乳腺癌(TNBC),3组的比例分别为72.3%(1 604/2 218)、10.1%(225/2 218)、17.5%(389/2 218),5年OS率分别为93.1%、88.3%和84.4%,5年RFS率(除外Ⅳ期乳腺癌)分别为87.7%、84.8%和76.7%。3组患者间5年OS率及RFS率相比,差异均有统计学意义(χ²＝24.124、31.668,P均<0.001)。在手术方式方面：本组患者保留乳房(简称保乳)率为24.8%(600/2 423)。Ⅰ期患者保乳率为44.9%(309/688),接受保乳者5年OS率比乳房全切者高(99.3%比98.4%,χ²＝6.338,P＝0.012),但5年RFS率与乳房全切者相比,差异无统计学意义(96.7%比94.8%,χ²＝2.245,P＝0.134);Ⅱ期患者保乳率为21.1%(237/1 125),保乳手术者与乳房全切者5年OS率分别为97.2%和92.7%,5年RFS率分别为88.5%和87.1%,组间比较,差异均无统计学意义(χ²＝3.793、1.425,P＝0.051、0.233)。在患者生存、复发影响因素方面：Cox比例风险回归模型显示,患者的年龄、临床分期、分子分型均与OS有关(HR＝1.017,95%CI：1.004～1.029,P＝0.019; HR＝3.242,95%CI：2.763～3.803,P<0.001;HR＝1.203,95%CI：1.066～1.357,P＝0.003)。 结论年龄、临床分期、分子分型是乳腺癌患者预后的影响因素。对于Ⅰ、Ⅱ期乳腺癌患者而言,保乳手术的疗效优于或不差于乳房全切术。     

手术方式对乳腺癌患者不同阶段生活质量的影响

背景与目的：随着医学模式的转变,肿瘤患者术后生活质量(quality of life)已成为评价整体治疗的重要标准之一。本研究旨在探讨不同手术方式对乳腺癌患者治疗和康复各阶段的生活质量的影响。方法：对2012年4月—2013年4月在北京同仁医院肿瘤中心手术后复查以及首次接受手术的乳腺癌患者共207例进行生活质量评定,其中保留乳房的乳腺癌切除术61例,全乳切除即刻乳房重建术60例,乳腺癌改良根治术86例,通过配对设计方法,使用量表进行调查,并进行统计学分析。结果：围手术期时,接受保乳手术或全乳切除即刻乳房重建手术的患者与接受改良根治术的患者主要在生理、情感和焦虑、抑郁等不良情绪水平方面差异有统计学意义(P<0.05),而在生活质量方面差异无统计学意义(P>0.05);术后2年和术后5年,接受保乳手术或全乳切除即刻乳房重建手术的患者与接受改良根治术的患者在生活质量方面差异有统计学意义(P<0.05),而在生理、情感和焦虑、抑郁等不良情绪水平方面差异无统计学意义(P>0.05)。结论：保留乳房的乳腺癌切除术和全乳切除即刻乳房重建手术较乳腺癌改良根治术可明显降低乳腺癌患者在围手术期焦虑、抑郁等不良情绪,并可不同程度提高患者的远期生活质量。     

乳腺癌肿瘤整形和乳房重建的趋势

正【内容简介】随着乳腺癌综合治疗的发展,患者生存期的延长,手术对患者身体外形、生活质量的影响受到越来越多的关注。对乳腺癌患者实施肿瘤整形手术,在不影响预后和复发的基础上,可帮助患者重塑身体外形,有利于患者自信地恢复正常的社会和生活角色。本期讲座中,吴炅教授介绍了国内外肿瘤整形技术发展趋势和肿瘤整形技术的首部国际专家共识,并对保留乳房(简称保乳)及乳房重建策略的选择、早期乳腺癌乳房重建手术类型、部分乳房重建(肿瘤整形保乳)、全乳切除术后乳     

乳腺癌术后即刻乳房重建的相关问题探讨

 乳腺癌术后乳房重建显著提高了患者的生活质量,已成为乳腺癌综合治疗的一个重要部分,但也暴露出一些盲目重建的问题。乳腺癌术后乳房重建的选择应综合考虑,即刻重建与保乳手术相比选保乳,即刻重建与延期重建相比尽量即刻再造乳房,假体重建与自体重建的选择也因人而异。总之,乳房重建应遵循根治基础上兼顾美容的原则。     

乳腺癌术后乳房重建手术与放疗间关系——基于中国110家医院横断面调查研究

目的 调查目前我国乳房重建手术开展现状,以及国内医生对放疗与乳房重建手术之间关系看法。方法 选取全国范围内110家乳腺癌年手术量>200例的医疗机构,以问卷调查形式开展研究,调查内容包括手术医师及其所在科室和医院的基本情况、2017年乳腺癌手术开展情况、各类型重建手术开展情况以及对放疗和重建手术关系的具体看法。结果 110家单位参与调研,96家(87.3%)单位已开展重建手术,植入物重建占总重建手术量的65.7%,自体重建占20.1%。对于可能需要术后放疗的患者,受访医院首选的手术方式为植入物重建,对于明确需要术后放疗和全乳切除术后接受过放疗的患者,首选自体组织重建。术后放疗是即刻乳房重建的阻碍因素,多数医院认为放疗对手术的影响不大。延期-即刻乳房重建的开展比例达到66%,86%的医院首选在放疗结束半年后更换假体。保乳术后复发的患者也可进行即刻重建,首选的手术方式为植入物重建。结论 我国乳房重建的比例开展较低,医生技术掌握仍有欠缺,在面对与放疗的冲突时,国内专科医生的选择与指南和共识尚存在出入,提示需要对医生进行更专业的培训,以进一步推动国内乳房重建事业的发展。     

保乳术治疗乳腺癌的中远期效果及术后复发因素分析

目的 探究保乳术治疗乳腺癌的中远期效果及术后复发因素。方法 选择乳腺癌患者180例,依据手术方式不同分为保乳组54例及传统组126例。保乳组采用保乳术治疗,传统组行改良根治术。比较2组围术期情况、复发率、3年生存率及5年生存率。分析保乳组术后复发的相关因素(依据病灶是否复发分为复发组及未复发组)。结果 保乳组手术时间、引流时间、住院时间均短于传统组,术中出血量、引流量均少于传统组,差异有统计学意义(P<0.05)。2组复发率、3年生存率及5年生存率比较,差异无统计学意义(P>0.05)。保乳组术后复发组年龄<40岁、有淋巴结转移、TNM分期Ⅱ期、Her-2阳性型发生率均高于未复发组,差异有统计学意义(P<0.05);年龄、淋巴结转移、TNM分期、分子分型是影响保乳组术后复发的独立危险因素(OR值≥1,且P<0.05)。结论 保乳术治疗乳腺癌对患者造成的创伤小、中远期效果好、疗效确切,患者住院时间短,但对年龄<40岁、伴有淋巴结转移、TNM分期Ⅱ期且Her-2阳性型患者需慎用保乳术,以降低术后复发风险。     

乳腺癌骨转移患者临床病理特征及预后影响因素分析：基于SEER数据库的回顾性研究

目的探讨乳腺癌骨转移患者的临床病理特征,并分析其预后情况及相关影响因素。 方法根据纳入及排除标准,利用美国国立癌症研究所监测、流行病学和结果(SEER)数据库检索并筛选1975年1月至2016年12月5 815例转移性乳腺癌患者资料进行回顾性分析,评估了患者临床病理特征、治疗方式及其预后。其中,乳腺癌骨转移组3 146例,乳腺癌非骨转移组2 669例。按照预后情况,将3 146例乳腺癌骨转移患者分为2个亚组：死亡组1 669例和存活组1 477例。利用χ²检验和Mann-Whitney U检验比较骨转移和非骨转移组患者临床病理特征的差异;用二元Logistic回归分析乳腺癌骨转移的影响因素;用Kaplan-Meier法进行生存分析,并用单因素log-rank检验分析乳腺癌骨转移患者中死亡组与存活组临床病理特征的差异;用多因素Cox比例风险回归模型筛选影响乳腺癌骨转移者生存情况的独立因素。 结果骨转移组和非骨转移组患者在T分期、N分期、组织学分级、人种、ER、PR、HER-2、肿瘤分子分型和预后方面比较,差异均有统计学意义(Z＝-5.71、-2.39、-13.87、χ²＝14.55、305.74、245.56、69.34、335.36、79.15,P均<0.050),2组间年龄、性别和原发灶位置比较,差异均无统计学意义(χ²＝0.57、2.71、0.45,P均>0.050)。Logistic回归分析结果显示：ER阳性、PR阳性、肿瘤T分期高和N分期高为导致乳腺癌患者骨转移的危险因素(OR＝1.775,95%CI：1.258～2.505,P＝0.001;OR＝1.425,95%CI: 1.236～1.643,P<0.001;OR＝1.095,95%CI：1.043～1.149,P<0.001;OR＝1.396,95%CI: 1.246～1.564,P<0.001),而组织学分级越高,发生骨转移的风险反而越小(OR＝0.815,95%CI：0.733～0.907,P<0.001)。骨转移组与非骨转移组患者的OS比较,差异均具有统计学意义(χ²＝133.53,P<0.001)。骨转移患者中,2个亚组(死亡组和存活组)患者在T分期、N分期、组织学分级、年龄、ER、PR、HER-2、肿瘤分子分型、原发灶手术、放射治疗和化疗方面比较,差异均有统计学意义(Z＝-7.75、-3.22、-8.14、χ²＝39.80、69.81、87.45、51.87、132.47、36.24、6.05、36.24,P均<0.050)。Cox比例风险回归模型多因素分析结果显示：年龄、T分期、N分期、PR、HER-2、肿瘤分子分型、组织学分级、化疗、放射治疗和原发灶手术是影响骨转移组患者预后的独立因素(HR＝1.349,95%CI: 1.195～1.523,P<0.001;HR＝1.151,95%CI: 1.101～1.203,P<0.001;HR＝ 1.077,95%CI: 1.033～1.123,P<0.001;HR＝ 0.715,95%CI: 0.626～0.817,P<0.001;HR＝0.695,95%CI: 0.627～0.770,P<0.001;HR＝1.349,95%CI: 1.260～1.414,P<0.001;HR＝1.371,95%CI: 1.261～1.489,P<0.001;HR＝0.626,95%CI：0.562～0.697,P<0.001;HR＝0.874,95%CI：0.791～0.966,P＝0.008;HR＝0.663,95%CI: 0.561～0.784,P<0.001)。 结论乳腺癌骨转移患者预后优于非骨转移患者,与年龄、T分期、N分期、PR、HER-2、肿瘤分子分型、组织学分级有关,治疗方面原发灶手术、放射治疗和化疗有助于改善骨转移患者的预后。     

体质指数对乳腺癌患者辅助内分泌治疗预后的影响

摘 要：［目的］ 探讨体质指数(BMI)对乳腺癌患者辅助内分泌治疗预后的影响。［方法］ 对653例乳腺癌患者进行回顾性分析,利用ROC曲线下面积方法计算出BMI的界点,并对患者进行分组,评估BMI对无病生存期(disease-free survival,DFS)及总生存(overall survival,OS)的影响。生存分析采用Kaplan-Meier法和Log-rank检验,单因素和多因素分析采用Cox比例风险模型。［结果］ 653例乳腺癌患者均为女性,其中BMI＜25.7kg/m2组患者458例(70.1%),BMI≥25.7kg/m2组195例(29.9%)。与BMI＜25.7kg/m2组患者比较,BMI≥25.7kg/m2组患者年龄较大(?字2=20.423,P＜0.001),绝经后患者所占比例多(?字2=22.261,P＜0.001)。BMI＜25.7kg/m2组患者的DFS显著地长于BMI≥25.7kg/m2组(P＜0.001)。然而,两组之间的OS差异无统计学意义(P= 0.266)。多因素分析显示,年龄、肿瘤大小、淋巴结转移、Ki-67水平、p53表达和BMI均为影响乳腺癌患者DFS的独立不良因素。［结论］超重与肥胖是影响乳腺癌患者辅助内分泌治疗预后的不良因素。     

早期乳腺癌乳头乳晕复合体隐匿癌浸润的临床病理研究

目的 探讨早期乳腺癌乳头乳晕复合体(NAC)隐匿浸润情况及其相关因素,为早期乳腺癌患者保留NAC的改良根治术、一期乳房再造提供理论依据.方法 对68例女性Ⅰ、Ⅱa期原发性乳腺癌患者,术前详细记录肿瘤位置、肿瘤大小、肿瘤缘距乳晕边缘的距离、乳头和乳腺皮肤有无异常表现、患侧腋窝和锁骨上有无可触及的肿大淋巴结.术中采集手术离体标本的NAC,采用横断多层面取材方法进行常规病理检查,免疫组化法检测乳腺癌组织中人类表皮生长因子受体2(HER-2)、雌激素受体(ER)和孕激素受体(PR)的表达.结果 本组患者NAC浸润率为13.2%.Ⅰ、Ⅱa期乳腺癌NAC浸润率随肿瘤缘距乳晕边缘距离的增加而下降,腋窝淋巴结有转移时NAC浸润率较无转移时高,HER-2过度表达者NAC浸润率较HER-2正常表达者高,病灶位于中央区与位于其他象限者NAC浸润率差异有统计学意义,肿瘤大小、TNM分期、乳头临床表现异常也可影响NAC的浸润,患者年龄、病理类型、ER和PR状态并不影响NAC的浸润.结论 影响早期乳腺癌患者NAC癌浸润的主要因素有肿瘤的位置、大小、临床分期、肿瘤缘距乳晕边缘的距离、乳头的临床表现、腋窝淋巴结状态以及癌组织中HER-2的表达.     

可手术乳腺癌6263例临床分析

背景与目的:欧、美国家的乳腺癌患者以中老年居多,中位年龄约57岁左右;改良根治术已取代传统根治术而被称为标准根治术,早期患者则行保乳手术;肿瘤的分期(尤其淋巴结状况)明显影响预后;辅助治疗能提高疗效。在国内,有关乳腺癌临床研究的大宗报道甚少。本研究分析我院可手术乳腺癌6263例的临床特点、手术方式与治疗效果,分析影响预后的因素和辅助治疗的作用等情况,以期提高乳腺癌的诊治水平。方法:将我院1964年6月～2003年6月收治的6263例可手术乳腺癌的临床资料输入计算机并分析可手术乳腺癌患者年龄的分布和临床特点。用SPSS10.0统计软件,分析手术术式与治疗效果以及影响预后的因素和辅助治疗的作用等情况。结果:6263例可手术乳腺癌中,女性占98.8%。按每5岁年龄段计算,45～49岁最多(25.2%)。按每10岁年龄段计算,40～49岁最多(41.0%)。临床表现以乳腺肿块为主(96.2%)。全组总5年和10年生存率分别为75.2%和40.4%,0～Ⅰ期、Ⅱ期和Ⅲ期的5年生存率分别为96.8%、73.7%和46.4%,10生存率则分别为78.7%、64.6%和33.5%。腋窝淋巴结阴性和阳性的5年生存率分别为80.3%和55.6%,而10年生存率分别为59.2%和31.9%。20世纪80年代后作传统根治术和改良根治术后各期的5年和10年生存率相比较,均无统计学意义(P>0.05)。早期     

Determinants of receiving immediate breast reconstruction: An analysis of patient characteristics at a tertiary care center in the US

BackgroundBreast reconstruction is an option for women undergoing mastectomy for breast cancer. Previous studies have reported underutilization of reconstructive surgery. This study aims to examine the role demographic, clinical and socio-economic factors may have on patients’ decisions to undergo breast reconstruction.MethodsWe analyzed data from our institutional database. Using multivariable and multinomial logistic regression, we compared breast cancer patients who had undergone mastectomy-only to those who had immediate breast reconstruction (overall and by type of reconstruction).ResultsWe analyzed data on 1459 women who underwent mastectomy during the period 2003–2015. Of these, 475 (32.6%) underwent mastectomy-only and 984 (67.4%) also underwent immediate breast reconstruction. After adjusting for potential confounders, older age (OR = 0.18, 95%CI:0.08–0.40), Asian race (OR = 0.29, 95%CI:0.19–0.45), bilateral mastectomy (OR = 0.71, 95%CI:0.56–0.90), and higher stage of disease (OR = 0.44, 95%CI:0.26–0.74) were independent risk factors for not receiving immediate breast reconstruction. Furthermore, patients with Medicare or Medicaid insurance were less likely than patients with private insurance to receive an autologous reconstruction. There was no evidence for changes over time in the way socio-demographic and clinical factors were related to receiving immediate breast reconstruction after mastectomy.ConclusionsClinical characteristics, sociodemographic factors like age, race and insurance coverage affect the decision for reconstructive surgery following mastectomy.     

Health-related quality of life and patient satisfaction after treatment for breast cancer in northern Taiwan

PURPOSE: To evaluate health-related quality of life (QoL) and attitudes toward surgical procedures for breast cancer among patients in northern Taiwan. METHODS AND MATERIALS: Two hundred twenty posttreatment breast cancer patients completed a QoL survey at two different hospitals in northern Taiwan. Patients (median age, 49 years; range, 32-69 years) had either undergone mastectomy (n = 157) or breast conservation treatment (BCT) (n = 63). The Functional Assessment of Chronic Illness Therapy-Breast questionnaire was used to assess QoL. The patients were also asked about breast reconstruction or use of an artificial breast or not, as well as the decision-making process. RESULT: There was no significant difference in QoL between patients treated with BCT or mastectomy. Significantly more mastectomy patients had had breast reconstruction or wore an artificial breast (49.7% vs. 3.2%; p < 0.001). Of those who had BCT, 81% would make the same choice again, compared with only 49% of mastectomy patients (p < 0.001). Only 7.6% of patients who made the treatment decision themselves were dissatisfied with their treatment, compared with 25% for whom the decision was made by someone else (p = 0.004). CONCLUSIONS: Taiwanese women with breast cancer who had undergone mastectomy did not report a worse QoL than those who received BCT, but they were more likely to be concerned about their resulting body image. Half would have chosen a less extensive procedure if they had it to do over. Women were more likely to be satisfied with the results of their treatment if they had decided themselves.     

乳腺癌新辅助化疗后改良根治术后放疗开始时间对预后的影响

目的 本研究旨在分析接受新辅助化疗的局部晚期乳腺癌患者改良根治手术时间到放疗开始时间(SRI)对患者预后的影响。方法 回顾性分析全国11家肿瘤中心的1087例接受新辅助化疗和改良根治术后放疗的乳腺癌患者。用Maxstat方法寻找手术到放疗间隔时间对预后影响的最佳界值。采用Cox多因素回归和倾向配比评分(PSM)分析手术距放疗间隔时间对预后的影响。结果 全组中位随访72.9个月,5年无瘤生存(DFS)率和总生存(OS)率分别为68.1%和81.8%。全组患者分为SRI≤18周(917例)和 SRI>18周(170例)两组。多因素分析显示激素受体状态、病理T分期、病理N分期和SRI是DFS影响因素(P<0.001、<0.001、<0.001、0.023)。激素受体状态、病理T分期、病理N分期、内分泌治疗和SRI是OS影响因素(P=0.013、0.006、<0.001、0.013、0.001)。采用PSM均衡两组患者临床病理因素后SRI≤18周患者DFS和OS仍然优于SRI>18周者。结论 新辅助化疗后乳腺癌患者改良根治手术到放疗间隔时间影响预后,患者应尽量在手术后18周内开始放疗。     

The effect of ethnicity on immediate reconstruction rates after mastectomy for breast cancer

BACKGROUND: Multiple factors may influence whether patients undergo immediate breast reconstruction along with mastectomy for breast cancer. The authors investigated whether ethnicity was an independent predictor of immediate breast reconstruction. METHODS: The authors identified 1004 patients who underwent mastectomy for breast cancer during the period 2001-2002. The rates of immediate reconstruction among different ethnicities were evaluated using the chi-square test. Logistic regression was used to adjust for covariates, including age and disease stage. Medical records were analyzed to identify factors that influenced each patient's decision for or against immediate breast reconstruction. RESULTS: Three hundred seventy-six women (37.5%) underwent immediate breast reconstruction: This included 20.2% of African-American women, compared with 40.0% of white women, 42.0% of Hispanic women, 42.2% of Asian women, and 10.0% of Middle Eastern women (P < 0.001). The unadjusted odds ratio (OR) for immediate reconstruction for African-Americans versus whites was 0.38 (95% confidence interval [95% CI], 0.23-0.63; P < 0.001). After multivariate analysis, this disparity persisted, with an adjusted OR of 0.34 (95% CI, 0.18-0.62; P = 0.001). Asian women had lower rates of immediate reconstruction compared with white women (adjusted OR, 0.50; 95% CI, 0.24-1.04; P = 0.06). Hispanic women did not have immediate reconstruction rates that differed significantly from white women. Middle Eastern women had lower rates of immediate reconstruction compared with white women (adjusted OR, 0.08; 95% CI, 0.02-0.38; P = 0.002), but they had a corresponding increase in the rate of delayed reconstruction. In a stepwise analysis of the decision pathway to immediate reconstruction, it was found that African-American women were less likely to be offered referrals for reconstruction, were less likely to accept offered referrals, were less likely to be offered reconstruction, and were less likely to elect reconstruction if it was offered. CONCLUSIONS: African-American women underwent immediate breast reconstruction at significantly lower rates compared with white women, Hispanic women, and Asian women. After adjusting for covariates, including age and disease stage, African-American women and Asian women had lower rates of reconstruction compared with white women. The factors that contribute to these differences warrant further study.     

Persistent disparities in breast cancer surgical outcomes among hispanic and African American patients

BackgroundRacial disparities among patients who receive breast mastectomy and reconstruction have not been well characterized.MethodsRecords of patients undergoing breast extirpative and reconstructive surgery at a high-volume university-affiliated hospital over 5 consecutive years were reviewed. Patient demographics, breast cancer profiles, reconstructive modality, and outcomes were compared by race.ResultsA total of 1045 patients underwent 1678 breast reconstructions during the five-year period. Mean age and standard deviation was 49.8 ± 10.6 years with a BMI of 27.9 ± 6.5. Hispanic and African American patients had significantly higher BMIs (p < 0.001), higher rates of ASA class III or IV (p = 0.025), obesity, diabetes, hypertension (p < 0.001 for these three comparisons), and smoking (p = 0.003), and had more prior abdominal surgeries (p = 0.007). Comparing oncologic characteristics, this population subset had higher rates of neoadjuvant chemotherapy (p = 0.036), history of radiation (p = 0.016), and were more likely to undergo modified radical mastectomy (p = 0.002) over nipple-sparing mastectomy (p = 0.035). Reconstructive complications revealed a higher overall complication rate (p = 0.023), higher rates of partial mastectomy flap necrosis (p = 0.043), as well as arterial (p = 0.009) and venous insufficiency (p = 0.026) during microvascular reconstruction among Hispanic and African American patients.ConclusionsCompared to other patients, the present study identifies higher comorbidity burdens, higher rates of prior radiation and neoadjuvant chemotherapy, and higher post-surgical complication rates among Hispanic and African American patients with breast cancer.     

Oncoplastic breast conservation occupies a niche between standard breast conservation and mastectomy – A population-based prospective audit in Scotland

IntroductionThe role of oncoplastic breast conservation (OBC) surgery is not fully defined in terms of whether it is equivalent to standard breast conservation (SBC), or more an alternative to mastectomy, or whether it occupies its own niche somewhere between the two. Therefore, we have carried out a population-based prospective audit of the current OBC practice in Scotland.MethodsAll patients diagnosed with breast cancer in the whole of Scotland between 01/01/2014 and 31/12/2015 were prospectively recorded within the National Managed Clinical Networks databases. Patients treated with OBC were compared to patients who had SBC, mastectomy and mastectomy with immediate reconstruction (MIR).Results8075 patients were included (OBC:217(2.7%); SBC:5241(64.9%); mastectomy:1907(23.6%); MIR:710(8.8%)). OBC patients were younger than SBC or mastectomy, but older than MIR (p < 0.0001). OBC patients were between SBC and mastectomy patients in terms of clinical and pathological tumour size (all p < 0.001), rates of lobular cancers (v.SBC:p = 0.015 and v.mastectomy:p < 0.001), high-grade tumours (v.SBC:p = 0.030 and v.mastectomy:p = 0.008), ER negative (v.SBC: p = 0.042) and HER-2 positive (v.SBC: p = 0.003) tumours, and nodal metastasis (v.mastectomy: p < 0.001). More OBC patients received (neo)adjuvant chemo- and hormonal therapy (p ≤ 0.001), adjuvant radiotherapy (p = 0.005), trastuzumab (p < 0.001) than SBC. More OBC patients presented through screening (v.mastectomy/MIR: p < 0.0001). Time to surgery from diagnosis was longer for OBC than SBC/mastectomy (p < 0.0001), but shorter than MIR (p = 0.007).ConclusionThis national audit demonstrates that OBC occupies its own niche between SBC, mastectomy and MIR in the surgical treatment of breast cancer in Scotland. We recommend that OBC should be recorded separately in other national breast cancer registries.     

IMMEDIATE BREAST RECONSTRUCTION WITH LATISSIMUS DORSI MUSCULOCUTANEOUS FLAP： A SUITABLE OPTION FOR CHINESE WOMEN AFTER MASTECTOMY

Objective： To discuss the suitable immediate breast reconstruction modalities for Chinese patients by comparing the pedicled transverse rectus abdominis myocytaneous flap （TRAM） reconstruction with latissimus dorsi myocytaneous flap （LTD） reconstruction plus implants or not after mastectomy due to breast cancer. Methods： From Jan. 2000 to Jul. 2005, 74 staged 0-II patients （mean age 39） were performed immediate breast reconstruction with autologous tissue either using LTD flaps or pedicled TRAM flaps with supplemental implants when necessary after mastectomy due to breast cancer and the charts were reviewed. Results： The age, marriage and menses status did not affect the selection of modalities and the need of implants. In 74 patients, 62 cases （83.8%） were performed LTD reconstruction with 13 implants and 12 cases received TRAM with 1 implant. The difference in need of implants or not between the two modalities had no statistical significance （P=0.442, Fisher＇ exact test）. Aesthetic results judged as good or fair were in 88% patients and the cosmetic effects between LTD and TRAM groups or implant and non-implant groups had no differences. All reconstructions were successful, with 4.1% cumulative locoregional recurrence and 100% overall survival by following up to 66 months （median 9 months）. The DFS and RFS between the two modalities had no significant differences by log rank test. Conclusion： Immediate autologous tissue reconstruction makes it possible to regain the natural and symmetric contour of breast without increased local recurrence. The LTD flap reconstruction is a suitable option for most Chinese women as well as the pedicled TRAM flap.     

Regret and Quality of Life After Mastectomy With or Without Reconstruction

BackgroundMastectomy represents a deep burden for women with breast cancer. Very little is known about the psychological consequences over time and the quality of life (QoL) of women so treated, with or without breast reconstruction (BR).Patients and MethodsA total of 709 patients underwent mastectomy with or without BR between 2002 and 2012 at one institution. Among 468 surviving patients, a 60-query QoL questionnaire on personal issues including some European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire items was presented either by email, letter, or telephone interview.ResultsOf those questioned, 328 patients participated, whereas 140 (30%) declined the invitation or were unavailable. The median age was 63 years (range, 30-93 years). Stage I or II of disease was recorded in 73% of patients. Immediate BR was performed in 168 (51%) of 328 patients. Of the remaining patients, only 7 (4%) of 160 proceeded to delayed BR. Younger women had significantly worse Emotional Functioning and Social Functioning (SF) scores (P < .001), independently of tumor stage, and immediate BR improved that (P = .02). SF score was also worsened by chemotherapy (P = .03). Cognitive Functioning score was independent of age, BR, stage, or adjuvant therapies. Body Image and Sexual Functioning scores improved with BR (P < .03), and age was a strong co-variable (P < .001). On multivariate analysis, immediate BR was correlated with age and preoperative plastic surgery consultation. Some 68 (21%) of 328 patients regretted their decision or were disappointed with their choice regarding BR.ConclusionsYounger patients with breast cancer report a worse impact on their Emotional Functioning and SF scores after mastectomy, both of which are improved by BR. Reconstructing the breast at the time of mastectomy has a significant impact on Body Image and Sexual Functioning scores. A preoperative plastic surgeon consultation improves the rate of immediate BR, whereas delayed reconstruction is rarely adopted. Some 20% of patients are disappointed in or regret their decision regarding BR. We need to improve our management in consideration of these findings.