初诊四期乳腺癌女性乳房重建是否值得

　　大约2%～6%的乳腺癌患者初诊时已经发生远处转移，即初诊四期乳腺癌。原发肿瘤术后乳房重建对于初诊四期乳腺癌的意义仍然存在争议。

　　2020年8月25日，美国乳腺外科医师学会和美国肿瘤外科学会《肿瘤外科学报》在线发表梅奥医学中心的研究报告，对初诊四期乳腺癌患者乳房切除术后进行或未行乳房重建的结局进行了比较。

　　该单中心回顾研究利用梅奥医学中心乳腺癌手术前瞻维护数据库对2008年1月～2018年12月全部29例初诊四期乳腺癌乳房切除术后患者的患者特征、手术特征、生存结局数据进行分析。

　　结果，其中8例（28%）重建，21例（72%）未重建。

　　重建与未重建的患者组相比，术前全身治疗临床完全缓解比例：

• 原发肿瘤：50%比5%

• 远处转移：63%比39%

　　重建与未重建的患者组相比：

• 并发症发生比例相似：13%比10%（P=1.0）

• 两年总生存比例较高：100%比85%（95%置信区间：68%～100%）

• 五年总生存比例较高：100%比50%（95%置信区间：27%～91%，P=0.046）

　　因此，该研究结果表明，对于经过适当筛选的初诊四期乳腺癌年轻患者，如果全身治疗缓解情况良好且预计可长期生存，乳房切除术后乳房重建不失为合理选择之一，故有必要进一步开展多中心大样本研究进行验证。

Ann Surg Oncol. 2020 Aug 25. Online ahead of print.

Breast Reconstruction in the Setting of Stage 4 Breast Cancer: Is It Worthwhile?

Asaad M, Meaike J, Yonkus J, Hoskin T, Hieken T, Martinez-Jorge J, Tran N, Nguyen MD, Boughey J, Degnim AC.

Mayo Clinic, Rochester, MN, USA.

BACKGROUND: The role of reconstruction after primary tumor surgery for metastatic breast cancer remains controversial. This report describes the outcomes for patients undergoing mastectomy with and without reconstruction in the setting of de novo stage 4 breast cancer.

METHODS: Using a prospectively maintained institutional breast surgery database, this study identified all patients who presented with de novo stage 4 breast cancer from January 2008 to December 2018. Patients were included if they had undergone mastectomy with or without reconstruction. Patient, surgical characteristics, and survival outcomes were abstracted and analyzed.

RESULTS: The study identified 29 patients: 8 patients (28%) who underwent reconstruction (R) and 21 patients (72%) who did not (NR). Complete clinical response to induction systemic therapy was more frequent among patients in the R group than among those in the NR group for the primary disease (50% in R, 5% in NR), and to a lesser degree for distant disease (63% in R, 39% in NR). No difference in complication rates between the two groups was identified [n = 1 (13%) in R; n = 2 (10%) in NR; p = 1.0]. Overall survival from surgery was longer in the R group (100% at 2 and 5 years) than in the NR group [85%; 95% confidence interval (CI), 68-100% at 2 years vs 50%; 95% CI 27-91% at 5 years] (p = 0.046).

CONCLUSION: Breast reconstruction after mastectomy may be reasonable to consider for appropriately selected patients with de novo stage 4 breast cancer who have excellent responses to systemic therapy and anticipated durable survival.

PMID: 32840744

DOI: 10.1245/s10434-020-08879-8