众所周知，对于高风险乳腺癌女性，乳房切除术后放疗可以显著减少局部复发率和乳腺癌相关死亡率。不过，乳房切除术后放疗对于乳房切除重建术后再次手术率的影响尚不明确。
2019年1月23日，美国乳腺外科医师学会和肿瘤外科学会《肿瘤外科学报》在线发表复旦大学附属肿瘤医院上海医学院张丽、金恺睿、汪宣伊、杨昭志、汪隽琦、马金利、梅欣、陈星星、王小方、罗菊锐、吴炅、邵志敏、章真、俞晓立、郭小毛等学者的研究报告，探讨了乳房切除术后放疗对乳腺癌患者乳房切除重建术后再次手术率的影响。
该研究对2001年6月～2015年12月在复旦大学附属肿瘤医院接受乳房切除重建手术的832例乳腺癌患者进行回顾分析，其中159例接受了乳房切除术后放疗，其余673例未接受乳房切除术后放疗。乳房重建术后再次手术分为三类：计划、意外、其他。重建类型包括即刻重建、延迟重建、扩张重建（一期植入扩张器后二期重建）。对相关影响因素进行校正后，根据不同的乳房重建类型，通过多因素逻辑回归模型，评估乳房切除术后放疗对所有再次手术和意外再次手术的影响。
结果，中位随访58.5个月（范围：12.3～176.0个月）期间共对832例乳腺癌患者进行了1298次手术，所有再次手术和意外再次手术分别占46.2%和7.7%。
多因素分析表明，乳房切除术后放疗与否相比：
植入重建所有再次手术率相似（比值比：1.00，95%置信区间：0.43～2.37，P=0.995）
自体重建所有再次手术率相似（比值比：0.85，95%置信区间：0.52～1.40，P=0.533）
植入重建意外再次手术率较高（比值比：3.05，95%置信区间：1.20～7.75，P=0.019）
自体重建意外再次手术率相似（比值比：1.17，95%置信区间：0.51～2.66，P=0.713）
延迟重建与即刻重建相比：
自体重建所有再次手术率较高（比值比：3.55，95%置信区间：1.61～7.83，P=0.002）
自体重建意外再次手术率较高（比值比：3.95，95%置信区间：1.48～10.59，P=0.006）
扩张重建与即刻重建相比：
植入重建所有再次手术率较高（比值比：9.53，95%置信区间：6.04～15.04，P<0.001）
植入重建意外再次手术率较高（比值比：2.02，95%置信区间：1.32～3.09，P=0.001）
因此，该研究结果表明，乳房切除术后放疗可能增加植入重建患者意外再次手术风险，但是对于自体重建患者影响不大。当计划乳房切除术后放疗、选择合适的乳房重建类型时，应该考虑再次手术的风险。
Ann Surg Oncol. 2019 Jan 23. [Epub ahead of print]
The Impact of Radiotherapy on Reoperation Rates in Patients Undergoing Mastectomy and Breast Reconstruction.
Zhang L, Jin K, Wang X, Yang Z, Wang J, Ma J, Mei X, Chen X, Wang X, Zhou Z, Luo J, Wu J, Shao Z, Zhang Z, Yu X, Guo X.
Fudan University Shanghai Cancer Center, Shanghai, China; Shanghai Medical College, Fudan University, Shanghai, China.
OBJECTIVE: The aim of this study was to determine the impact of postmastectomy radiotherapy (PMRT) on reoperation rates in women with breast cancer undergoing mastectomy and breast reconstruction.
METHODS: Between June 2001 and December 2015, 832 breast cancer patients treated with mastectomy and breast reconstruction with (n = 159) or without (n = 673) PMRT were analyzed retrospectively. Reoperations following breast reconstruction were categorized into the following three types: anticipated, unanticipated, and others. Multivariable logistic regression models were used to evaluate the impact of PMRT on overall and unanticipated reoperations according to different breast reconstruction types after adjusting for relevant covariates.
RESULTS: With a median follow-up of 58.5 months, a total of 1298 operations were performed in 832 breast cancer patients. The rates of overall and unanticipated reoperations were 46.2% and 7.7%, respectively. Multivariable analysis showed that PMRT was not associated with overall reoperations in either implant-based reconstruction patients (odds ratio [OR] 1.00, 95% confidence interval [CI] 0.43-2.37, p = 0.995) or autologous reconstruction patients (OR 0.85, 95% CI 0.52-1.40, p = 0.533); however, the impact of PMRT on unanticipated reoperations differed by reconstruction type. In patients who received implant-based reconstructions, PMRT was associated with a 3.05-fold (95% CI 1.20-7.75, p = 0.019) higher odds of unanticipated reoperations, while there was no difference in patients who underwent autologous reconstruction (OR 1.17, 95% CI 0.51-2.66, p = 0.713). Delayed reconstruction or delayed-immediate reconstructions were associated with an increased risk of both overall and unanticipated reoperations in both reconstruction cohorts.
CONCLUSIONS: PMRT appears to be associated with an increased risk of unanticipated reoperations among patients receiving implant-based reconstruction, but not among those receiving autologous reconstruction. The risk of reoperation should be taken into consideration when selecting the appropriate breast reconstruction type when PMRT is planned.
PMID: 30675702
DOI: 10.1245/s10434-018-07135-4
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