应用不同重建手术保留乳腺癌患者乳头乳晕的疗效比较及预后分析

doi:10.3969/j.issn.1006-5725.2023.22.008

Abstract

Abstract:

Objective To investigate the safety， efficacy and influencing factors of nipple-sparing mastectomy with different reconstruction methods. Methods A total of 1408 patients who underwent nipple-sparing breast reconstruction in Shanghai Jiaotong University Breast Cancer Database from March 2010 to March 2022 were retrospectively analyzed. According to the reconstruction method， they were divided into one-stage group （n = 876） and two-step group （n = 532）. The cosmetic effect of breast appearance， satisfaction， complications， postoperative recurrence rate and quality of life were compared between the two groups. According to the recurrence， the patients were divided into recurrence group （n = 162） and non-recurrence group （n = 1 246）. Univariate and multivariate Logistic regression analysis were used to analyze the influencing factors of recurrence after nipple-sparing mastectomy. Results The excellent rate of breast appearance and postoperative satisfaction in the one-step group were significantly higher than those in the two-step group （P < 0.05）. There was no significant difference in the incidence of complications and local recurrence between the two groups （P > 0.05）. Six months after surgery， the FACT-B scores of the two groups were higher than those before surgery， and the FACT-B scores of the one-step group were higher than those of the two-step group （P < 0.05）. The proportion of patients older than 35 years old， with invasive cancer of no special type， without endocrine therapy， and without radiotherapy in the recurrence group was significantly higher than that in the non-recurrence group （P < 0.05）. Multivariate Logistic regression analysis showed that age > 35 years old， invasive cancer of no special type， and no adjuvant radiotherapy were independent risk factors for recurrence of reconstruction surgery in patients with nipple-sparing mastectomy for breast cancer （P < 0.05）. Conclusions One-step reconstruction has high application value for the patients undergoing radical mastectomy and is worthy of widespread clinical promotion. Age > 35 years， invasive non-specific cancer， and no adjuvant radiotherapy were independent risk factors for recurrence in patients undergoing radical mastectomy with nipple areola preservation.

Key words: breast cancer, nipple-sparing mastectomy, reconstructive surgery, the influencing factors, complications

CLC Number:

R76.3

Yao MENG,Zhao LIU,Jing ZHANG,Changxiao. ZHAO. Comparison of curative effect and prognosis of preserving nipple and areola in patients with breast cancer by different reconstruction operations[J]. The Journal of Practical Medicine, 2023, 39(22): 2903-2908.

Figures/Tables 7

Tab.1

Tab.2

Tab.3

Tab.4

Tab.5

Tab.6

Tab.7

References 20

1	荀雷，陈红，史珂.不同放疗技术用于乳腺癌根治术后的疗效及对患者预后的影响［J］.实用癌症杂志，2022，37（9）：1537-1540，1548.
2	HONG B， BANG S， OH C， et al. Comparison of PECS II and erector spinae plane block for postoperative analgesia following modified radical mastectomy： Bayesian network meta-analysis using a control group［J］. J Anesth，2021，35（5）：723-733.
3	雷少元，郑荣寿，张思维，等.乳腺癌发病率和死亡率的全球模式：一项基于人群的2000-2020年肿瘤登记数据分析研究［J］.癌症，2022，41（7）：324-335.
4	ROSSI L， MAZZARA C， PAGANI O. Diagnosis and Treatment of Breast Cancer in Young Women［J］. Curr Treat Options Oncol，2019，20（12）：86.
5	KAUFMAN C S. Increasing Role of Oncoplastic Surgery for Breast Cancer［J］. Curr Oncol Rep，2019，21（12）：111.
6	MATAR D Y， WU M， HAUG V， et al. Surgical complications in immediate and delayed breast reconstruction： A systematic review and meta-analysis［J］. J Plast Reconstr Aesthet Surg，2022，75（11）：4085-4095.
7	JAGSI R， MASON G， OVERMOYER B A，et al. Komen-IBCRF IBC Collaborative in partnership with the Milburn Foundation. Inflammatory breast cancer defined： proposed common diagnostic criteria to guide treatment and research［J］. Breast Cancer Res Treat，2022，192（2）：235-243.
8	NAHVIJOU A， SAFARI H， YOUSEFI M， et al. Mapping the cancer-specific FACT-B onto the generic SF-6Dv2［J］. Breast Cancer，2021，28（1）：130-136.
9	JAFARI S H， SAADATPOUR Z， SALMANINEJAD A，et al.Breast cancer diagnosis： Imaging techniques and biochemical markers［J］. J Cell Physiol，2018，233（7）：5200-5213.
10	GILMOUR A， CUTRESS R， GANDHI A，et al.Oncoplastic breast surgery： A guide to good practice［J］. Eur J Surg Oncol，2021，47（9）：2272-2285.
11	缪华章，吴云涛，朱颖贤. 2017-2019年广东省农村适龄妇女宫颈癌和乳腺癌筛查结果和成本效果分析［J］. 实用医学杂志， 2023，39（13）：1709-1713.
12	SISTI A. Nipple-Areola Complex Reconstruction［J］. Medicina （Kaunas），2020，56（6）：296.
13	张超，孙海慧，李杰，等. 2012-2016年京津冀地区382例乳腺癌术后即刻乳房重建临床分析［J］. 中华外科杂志，2020，58（2）：105-109.
14	BARGON C A， YOUNG-AFAT DA， IKINCI M， et al. Breast cancer recurrence after immediate and delayed postmastectomy breast reconstruction-A systematic review and meta-analysis［J］. Cancer，2022，128（19）：3449-3469.
15	SHUMWAY D A， MOMOH A O， SABEL M S，et al. Integration of Breast Reconstruction and Postmastectomy Radiotherapy［J］. J Clin Oncol，2020，38（20）：2329-2340.
16	李国明，刘宝胤.腔镜下保留乳头乳晕的改良根治术及乳房Ⅰ期重建在早期乳腺癌中的应用价值［J］.腹腔镜外科杂志，2021，26（7）：525-529.
17	HANSON S E， LEI X， ROUBAUD M S， et al. Long-term Quality of Life in Patients With Breast Cancer After Breast Conservation vs Mastectomy and Reconstruction［J］.JAMA Surg，2022，157（6）：e220631.
18	CHOU H H， CHUNG W S， DING R Y， et al. Factors affecting locoregional recurrence in breast cancer patients undergoing surgery following neoadjuvant treatment［J］. BMC Surg，2021，21（1）：160.
19	TOMASICCHIO G， PICCIARIELLO A， STUCCI L S， et al. Outcome and risk factors for local recurrence after breast conserving surgery in patients affected by ductal carcinoma in situ［J］. Minerva Surg，2022，77（6）：536-541.
20	WU Z Y， HAN H H， HAN J， et al. Impact of Local Breast Cancer Recurrence on Reconstructed Breast in Nipple-Sparing Mastectomy with Immediate Reconstruction［J］. J Plast Reconstr Aesthet Surg，2022，75（8）：2535-2541.

组别	优	良	差	优良率	满意度
一步法组（n = 876）	656（74.89）	164（18.72）	56（6.39）	777（93.61）	754（86.07）
二步法组（n = 532）	211（39.66）	176（33.08）	145（27.26）	387（72.74）	421（79.14）
χ²值				58.870	11.536
P值				< 0.001	0.001

组别	生理状况		社会家庭状况		情感状况
组别	术前	术后6个月	术前	术后6个月	术前	术后6个月
一步法组（n = 876）	15.33 ± 4.06	17.75 ± 5.23^*	15.92 ± 4.93	18.41 ± 5.96^*	13.86 ± 3.40	15.99 ± 4.83^*
二步法组（n = 532）	15.19 ± 3.96	15.66 ± 4.83^*	15.47 ± 4.75	16.08 ± 5.16^*	13.58 ± 3.91	14.21 ± 3.90^*
t值	0.633	7.481	1.684	7.745	1.415	7.194
P值	0.527	< 0.001	0.092	< 0.001	0.157	< 0.001

组别	功能状况		附加关注状况		总分
组别	术前	术后6个月	术前	术后6个月	术前	术后6个月
一步法组（n = 876）	15.63 ± 3.81	18.88 ± 6.11^*	19.93 ± 5.16	23.26 ± 5.91^*	80.67 ± 21.36	94.29 ± 28.04^*
二步法组（n = 532）	15.79 ± 3.99	17.35 ± 5.96^*	20.65 ± 9.74	21.89 ± 9.77^*	80.68 ± 26.35	84.99 ± 29.22^*
t值	-0.750	4.598	-1.810	3.279	-0.008	5.983
P值	0.453	< 0.001	0.071	0.001	0.994	< 0.001

组别	上肢水肿	皮下积液	切口感染	出血	总发生率	局部复发率
一步法组（n = 876）	71（8.11）	38（4.34）	1（0.11）	1（0.11）	111（12.67）	92（10.50）
二步法组（n = 532）	59（11.09）	24（4.51）	3（0.56）	1（0.19）	87（16.35）	70（13.16）
χ²值	3.520	0.024	2.363	0.127	3.713	2.293
P值	0.061	0.878	0.124	0.721	0.054	0.130

项目	复发组（n = 162）	非复发组（n = 1 246）	χ²值	P值
年龄			6.031	0.038
≤ 35岁	41（25.31）	698（56.02）
> 35岁	121（74.69）	548（43.98）
肿瘤大小			2.131	0.786
≤ 2 cm	78（48.15）	781（62.68）
> 2 cm	84（51.85）	465（37.32）
病理类型			5.916	0.034
导管癌早期浸润	2（1.23）	36（2.89）
浸润性非特殊型癌	152（93.83）	1069（85.79）
浸润性特殊型癌	8（4.94）	141（11.32）
淋巴结转移			1.161	1.211
阳性	72（44.44）	701（56.26）
阴性	90（55.56）	545（43.74）
内分泌治疗	63（38.89）	592（47.51）	4.285	0.038
未行放疗辅助治疗	71（43.83）	308（24.72）	26.608	< 0.001

Comparison of curative effect and prognosis of preserving nipple and areola in patients with breast cancer by different reconstruction operations

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 7

References 20

Related Articles 15

Recommended Articles

Metrics

Comments

因素	变量名	赋值
年龄	X1	> 35岁=1，≤ 35岁=2
浸润性非特殊型癌	X2	否=1，是=2
内分泌治疗	X3	否=1，是=2
未行放疗辅助治疗	X4	否=1，是=2
复发	Y	是=1，否=2

变量	β	SE	Waldx²	OR（95%CI）	P值
年龄> 35岁	1.396	0.268	3.153	2.113（4.031 ~ 7.532）	0.038
浸润性非特殊型癌	1.365	0.869	18.306	4.316（1.192 ~ 3.246）	< 0.001
未进行内分泌治疗	1.358	0.211	3.296	1.239（1.196 ~ 5.432）	0.056
未行放疗辅助治疗	1.294	0.951	4.126	0.932（0.543 ~ 4.141）	0.022

[1]	Xiaotong LIU,Xianhua SU,Zhijun XIN,Fengqiong GAO,Jiayi FENG,Tongxia. XIA. Risk factors of postoperative complications in patients with spinal tuberculosis and the predictive value of prognostic nutritional index [J]. The Journal of Practical Medicine, 2024, 40(7): 972-978.
[2]	Zixu SONG,Guangzheng ZHU,Chenxu GUO,Jiaqi WU,Ligong ZHANG,Jun. QIAN. Expression of SLC35A2 and PFDN2 in breast cancer and its relationship with clinical observables and prognosis [J]. The Journal of Practical Medicine, 2024, 40(4): 496-502.
[3]	Shenglong YUAN,Huanhuan HU,Zhen GONG. Efficacy of the ACS NSQIP surgical risk calculator in open radical hysterectomy [J]. The Journal of Practical Medicine, 2024, 40(2): 140-145.
[4]	Yinghua ZENG,Wenji LI,Li. ZHENG. The Impact of the timing of initial dressing change following PICC catheterization on postoperative breast cancer patients [J]. The Journal of Practical Medicine, 2024, 40(19): 2772-2777.
[5]	Che CHEN,Dehong LUO,Huangfei YU,Qin ZHANG,Xiaochi HU,Shenghua YU,Yajun. LI. Clinical Application of automatic delineation in whole breast radiotherapy with simultaneous integrated boost to the medial tumor beds [J]. The Journal of Practical Medicine, 2024, 40(17): 2406-2411.
[6]	Shaojin LI,Shipeng. ZHENG. Relevant preoperative imaging pathological features and tumor markers serve as predictive indicators for the risk of sentinel lymph node metastasis in breast cancer [J]. The Journal of Practical Medicine, 2024, 40(17): 2418-2424.
[7]	Lingyu FANG,Jinghua HU,Junfeng WEN,Shiqi HAN,Yali WANG,Lulan PU,Jingjia LI,Yi YANG,Shishan DENG,Lingmi HOU,Fangfang. ZHOU. Expression and significance of ubiquitin⁃specific proteases 20 and hypoxia inducible factor⁃1α in breast cancer [J]. The Journal of Practical Medicine, 2024, 40(16): 2270-2276.
[8]	Yihuan CHEN,Zhenya SHEN,Yunsheng YU,Haoyue HUANG,Wenxue YE,Fei HUA,Yanqiu. HU. Observation on the effects and complications of mitral valve membrane replacement surgery with preservation of mitral valve subvalvular structure on cardiac function and valve function [J]. The Journal of Practical Medicine, 2024, 40(15): 2092-2097.
[9]	Lingmin HE,Yunhao ZHANG,Xu SUN,Aobing. MEI. Progress of treatment strategy after obturator nerve injury during pelvic lymph node dissection [J]. The Journal of Practical Medicine, 2024, 40(15): 2183-2186.
[10]	Qizhu FENG,Zhe XU,Jie SUN,Jiaquan ZHANG,Sheng DING,Jian ZHANG,Qi WANG,Chao. ZHANG. Comparison of the effect of indocyanine green injection through peripheral vein and gallbladder in laparoscopic cholecystectomy of difficult gallbladder [J]. The Journal of Practical Medicine, 2024, 40(11): 1537-1541.
[11]	AI Yongbiao, HUANG Jun, YUAN Jie, LI Wenfang.. Androgen receptor expression in early triple negative breast cancer and its association with the clinicopath⁃ ological features and prognosis [J]. The Journal of Practical Medicine, 2023, 39(8): 975-979.
[12]	Ziyun LU,Hang SUN,Lu XU,Rusong YANG,Tao WANG,Minke SHI,Zhengliang MA,Yu′e SUN,Bingbing. LI. Risk factors of postoperative pulmonary complications in patients undergoing thoracic surgery in Day Care Unit [J]. The Journal of Practical Medicine, 2023, 39(24): 3205-3209.
[13]	Ruhai YAN,Lihong SUN,Yingtong YE,Ming. ZHANG. Clinical characteristics of 88 infants or young children with allergic rhinitis and follow⁃up after drug treatment [J]. The Journal of Practical Medicine, 2023, 39(23): 3101-3105.
[14]	Xiran SHI,Heng WANG,Libing HE,Zhiqiang QIU,Hongjian LI,Xiaoxue. XU. Advance in predicting lymph node metastasis of breast cancer by multimodal MRI [J]. The Journal of Practical Medicine, 2023, 39(22): 2861-2865.
[15]	Yadan CHE,Lixia. LI. Reaserch progress on small molecule anti⁃angiogenic drugs for advanced breast cancer [J]. The Journal of Practical Medicine, 2023, 39(22): 2866-2871.