Unit:
Faculty of MedicineLibrary of the School of Health Sciences
Author:
Siotos Charalampos
Dissertation committee:
Παγώνα Λάγιου, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Ανδρονίκη Νάσκα, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Gedge D. Rosson, Αναπληρωτής Καθηγητής, Johns Hopkins University
Νικόλαος Αρκαδόπουλος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Βασιλική Μπενέτου, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Ευαγγελία Σαμώλη, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Γκίκας Μαγιορκίνης, Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Παράγοντες επιλογής θεραπείας και προγνωστικοί παράγοντες στη χειρουργική αντιμετώπιση/αποκατάσταση των ασθενών με καρκίνο του μαστού
Translated title:
Predictors of reconstruction surgery and prognosis of breast cancer patients following mastectomy with and without reconstruction
Summary:
Introduction
Breast reconstruction is an option for eligible women following mastectomy prophylactically or therapeutic for breast cancer. Despite the potential benefits of reconstruction for women who are willing to undergo breast reconstruction, prior studies have reported underutilization of the procedure. Concerns regarding its oncologic safety by patients or physicians and health care disparities have been considered as potential causes of the underutilization of breast reconstruction. The present study aims to evaluate the association of breast reconstruction with breast cancer recurrence, and 5-year survival among breast cancer patients and examine the role demographic, clinical and socio-economic factors may have on patients' decisions to undergo breast reconstruction.
Materials and Methods
After obtaining appropriate ethical approval, we assessed the records of female patients diagnosed with breast cancer at Johns Hopkins Hospital (Baltimore, MD, USA) between 2003 and 2015. Patients with the information of interest were identified and divided into two cohorts; patients with mastectomy only, and patients with mastectomy and immediate breast reconstruction. Baseline differences among the two groups were examined by performing chi-square. We used Kaplan-Meier curves to compare unadjusted estimates of survival or disease recurrence. Data were modeled through Cox proportional hazards regression, using as outcomes time to death from any cause or time to cancer recurrence. We then performed multivariable and multinomial logistic regression to compare breast cancer patients who had undergone mastectomy-only to those who had immediate breast reconstruction (overall and by type of reconstruction).
Results
We identified approximately 1,500 women with breast cancer, of which 67% underwent mastectomy only, while 33% had mastectomy and immediate breast reconstruction. Kaplan-Meier survival estimates demonstrated a survival benefit among patients undergoing mastectomy and reconstruction. However, after adjusting for various clinical and socioeconomic variables, the observed survival benefit associated with breast reconstruction was not statistically significant [HR 0.78, 95% CI (0.53-1.13)]. Patients who underwent reconstruction had a similar rate of recurrence compared to mastectomy-only patients [HR 1.08, 95% CI (0.69-1.69)]. We also found that older age [OR 0.18, 95% CI (0.08-0.40)], Asian race [OR 0.29, 95% CI (0.19-0.45)], bilateral mastectomy [OR 0.71, 95% CI (0.56-0.90)], and higher stage of disease [OR 0.44, 95 % CI (0.26-0.74)] were independent risk factors for not receiving immediate breast reconstruction. Furthermore, patients with Medicare or Medicaid insurance were less likely than patients with private insurance to receive an autologous reconstruction. Average follow up was 5.1 years following diagnosis of breast cancer.
Conclusion
The study provides evidence that breast reconstruction is not associated with higher rates of recurrence or worse 5-year survival for female patients with breast cancer who underwent mastectomy. We identified clinical, sociodemographic factors, like age, race and insurance coverage that may affect the decision for reconstructive surgery following mastectomy. Continuous monitoring of utilization of breast reconstruction is necessary to identify potential barriers to access to reconstruction following mastectomy.
Main subject category:
Health Sciences
Keywords:
Cohort study, Breast cancer, Mastectomy, Breast ρeconstruction
Number of references:
185
