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

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

目的研究乳腺癌患者应用保留乳头乳晕的乳腺癌根治术后采用不同重建术的临床疗效及影响因素。方法回顾性分析2010年3月至2022年3月上海交通大学乳腺癌数据库中进行保留乳头乳晕的乳房重建手术的患者1408例,根据重建手术方法将其分为一步法组(n=876)和二步法组(n=532),比较两组患者乳房外观美容效果、满意度、并发症、术后复发率及生存质量;再根据患者复发情况将其分为复发组(n=162)和非复发组(n=1246),多因素logistic回归分析患者术后复发的危险因素。结果一步法组患者乳房外观优良率和术后满意度明显高于二步法组(P<0.05);两组患者的并发症发生率、局部复发率差异无统计学意义(P>0.05);术后六个月后两组患者的各项生命质量测定量表(FACT-B)评分均高于术前,并且一步法组患者的FACT-B评分均高于二步法组(P<0.05);复发组患者中年龄>35岁、浸润性非特殊型癌、未行内分泌治疗、未行放疗辅助治疗的比例明显高于非复发组(P<0.05);多因素logistic回归分析显示,年龄>35岁、浸润性非特殊型癌、未行放疗辅助治疗是影响患者术后复发的独立危险因素(P<0.05)。结论一步法重建术对乳腺癌根治术患者具有较高应用价值,值得临床广泛推广;年龄>35岁、浸润性非特殊型癌、未行放疗辅助治疗是影响保留乳头乳晕的乳腺癌根治术患者复发的独立危险因素。

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=1246).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.