首发转移性乳腺癌患者乳房切除后即刻乳房重建生存结局大数据分析

乳腺癌转移大多发生于复发时，如果首次发现乳腺癌时就已转移，被称之为首发转移。对于转移性乳腺癌，尤其首发转移患者，即刻乳房重建的争议较多。

2018年11月5日，爱思唯尔旗下《临床乳腺癌》在线发表复旦大学附属妇产科医院吴克瑾等学者的研究报告，对首发转移性乳腺癌患者乳房切除后即刻乳房重建的生存结局进行了大数据分析。

该研究通过美国癌症研究所监测流行病学最终结果（SEER）数据库，对1998年1月1日～2015年12月31日3万7497例单侧首发四期乳腺癌患者进行回顾分析，比较乳房切除术±即刻乳房重建的生存结局，探讨首发转移性乳腺癌即刻乳房重建的趋势。通过卡方检验和费希尔精确检验，比较临床病理特征分布。通过多因素逻辑回归，评估首发转移性乳腺癌即刻乳房重建的预测因素。通过多因素比例风险回归模型，校正整个人群和匹配队列的已知临床病理因素后，对生存结局进行比较。

结果，1998～2015年首发转移性乳腺癌患者乳房切除术后即刻乳房重建率为5.2%，由1998年的6.3%显著增加至2015年的16.8%。

接受即刻乳房重建的患者特征包括：年龄较小、肿瘤体积较小、淋巴结阳性较少、肺转移和激素受体阴性比例较低、经济条件较好、接受放疗和化疗比例较高。

虽然即刻乳房重建对于整个人群是乳腺癌相关生存和总生存的独立有利预后因素，但是匹配队列的乳腺癌相关生存和总生存无统计学显著差异（P=0.892和P=0.708）。

因此，该研究结果表明，权衡生活质量与潜在医疗负担和肿瘤风险后，有选择地对首发转移性乳腺癌进行即刻乳房重建，可能成为大家认可的做法。

Clin Breast Cancer. 2018 Nov 5. [Epub ahead of print]

Immediate breast reconstruction in de novo metastatic breast cancer: an analysis of 563 cases based on SEER database.

Hongliang Chen, Mingdi Zhang, Maoli Wang, Peng Zhang, Fang Bai, Kejin Wu.

Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.

BACKGROUND: There are much more controversies for immediate breast reconstruction (IBR) in metastatic breast cancer (MBC) patients.

MATERIALS AND METHODS: By using data from the Surveillance, Epidemiology, and End Results (SEER) database, de novo MBC patients undergoing mastectomy with or without IBR were enrolled. The trend of IBR in de novo MBC was explored. Comparisons of the distribution of clinical-pathological characteristics were evaluated using chi-square tests with Fisher's exact test. The predictors of IBR in de novo MBC were evaluated by multivariate logistic regression. The survival outcomes were compared by means of Cox hazards models adjusting for known clinical-pathological variables in the whole population and in the matched cohorts as well.

RESULTS: Between 1998 and 2015, 5.2% of the de novo MBC patients undergoing mastectomy received IBR. The rate of IBR increased significantly from 6.3% in 1998 to 16.8% in 2015. Patients undergoing IBR were younger, with smaller tumor size, less positive lymph nodes, lower proportion of negative hormone receptor and lung metastasis, and better economic status. They were also more likely to receive radiation and chemotherapy. Although IBR was an independent favorable prognostic factor for breast cancer-specific survival (BCSS) and overall survival (OS) in the whole population, there were no statistically significant differences between IBR and mastectomy for BCSS (P=0.892) and overall survival OS (P=0.708) in the well-matched analysis.

CONCLUSION: IBR in selected de novo MBC might be an accepted practice under best balance between quality of life and underlying healthcare burden and oncological risks.

KEY WORDS: immediate breast reconstruction, metastatic breast cancer, survival, population-based

DOI: 10.1016/j.clbc.2018.10.013

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