Breast reconstruction and quality of life five years after cancer diagnosis: VICAN French National cohort

[RECOMA study: Evaluation of quality of life and satisfaction after immediate or delayed breast reconstruction]

OBJECTIVE

Breast reconstruction after mastectomy, whether immediate or delayed, is an integral part of the overall management of breast cancer. However, up to 40 % of reconstructed patients are not satisfied with the aesthetic result. The primary objective of the study was to evaluate satisfaction and quality of life according to the reconstruction techniques used in our center. The secondary objectives were to identify the parameters that could influence satisfaction and quality of life after surgery, to list the main complications, and the number of operations required to consider the reconstruction process as completed.

METHOD

A retrospective monocentric study, RECOMA, was carried out at the CHRU Minjoz in Besançon. All patients who underwent immediate or delayed breast reconstruction between 2010 and 2021 were contacted by post or e-mail and asked to complete the standardized BREAST-Q postoperative module.

RESULTS

Of 508 patients contacted, 149 were included. Reconstructed patients reported satisfaction, but also "average" quality of physical and psychological sexual life. Only the surgeon's assessment was rated as "good". There was no significant difference in satisfaction and quality of life depending on the reconstruction method chosen. On the other hand, patients who underwent nipple areolar complex (NAC) reconstruction had a significantly higher psychic quality of life score (P=0.02). In addition, a significant decrease in physical satisfaction was observed over time(P=0.049). An average of 2.4 operations was required to consider breast reconstruction complete.

CONCLUSION

In our opinion, breast reconstruction is an essential procedure to be considered as soon as the indication for mastectomy is given, but it is a process that requires the patient to be prepared for a result that may be weaker than expected, may require several operations, and may be complicated.

Locally advanced breast cancer patients should be cautious about the immediate breast reconstruction after mastectomy: a pooling analysis of safety and efficacy

BACKGROUND

The purpose of this study was to compare safety and efficacy outcomes between immediate breast reconstruction (IBR) and mastectomy alone in locally advanced breast cancer patients.

METHODS

We conducted a comprehensive literature search of PUBMED, EMBASE, and Cochrane databases. The primary outcomes evaluated were overall survival, disease-free survival, and local recurrence. The secondary outcome was the incidence of surgical complications. All data were analyzed using Review Manager 5.3.

RESULTS

Sixteen studies, involving 15,364 participants were included in this meta-analysis. Pooled data demonstrated that patients underwent IBR were more likely to experience surgical complications than those underwent mastectomy alone (HR: 3.96, 95%CI [1.07,14.67], p = 0.04). No significant difference was found in overall survival (HR: 0.94, 95%CI [0.73,1.20], p = 0.62), disease-free survival (HR: 1.03, 95%CI [0.83,1.27], p = 0.81), or breast cancer specific survival (HR: 0.93, 95%CI [0.71,1.21], p = 0.57) between IBR group and Non-IBR group.

CONCLUSIONS

Our study demonstrates that IBR after mastectomy does not affect the overall survival and disease-free survival of locally advanced breast cancer patients. However, IBR brings with it a nonnegligible higher risk of complications and needs to be fully evaluated and carefully decided.

Network Pharmacology Analysis, Molecular Docking, and In Vitro Verification Reveal the Action Mechanism of Prunella vulgaris L. in Treating Breast Cancer

Background

Prunella vulgaris L. is effective in the treatment of breast cancer (BRCA); however, the underlying mechanism is still unclear. The aim of this study was to elucidate the mechanism of treatment of BRCA by P. vulgaris using network pharmacology and molecular docking technology, and to verify the experimental results using human BRCA MDA-MB-231 cells.

Methods

Active components and action targets of P. vulgaris were determined using the TCMSP™, SwissTarget Prediction™, and TargetNet™ databases. GeneCards™ and OMIM™ provided BRCA targets. After obtaining common targets, a protein-protein interaction (PPI) network was constructed using the STRING™ database, and Gene Ontology and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses were conducted using the Xiantao™ academic database. Cytoscape™ was used to construct "single drug-disease-component-target" and "single drug-disease-component-target-pathway" networks. The Human Protein Atlas™ was used to determine protein expression levels in BRCA cell lines. AutoDock tools™ were used to carry out molecular docking for the first 10 targets of quercetin and the PPI network. Finally, the abovementioned results were verified using cell experiments.

Results

We obtained 11 active components, 198 targets, and 179 common targets, including DUOX2, MET, TOP2A, and ERBB3. The results of KEGG pathway analysis screened 188 related signaling pathways and indicated the potential key role of PI3K-Akt and MAPK signaling pathways in the antibreast cancer process of P. vulgaris. The results of molecular docking showed that the first 10 targets of quercetin interacted well with the protein network. Cell experiments showed that quercetin effectively inhibited the proliferation of MDA-MB-231 cells by regulating apoptosis and cell cycle, which may be partly related to the MAPK signaling pathway.

Conclusion

Synergistic effects of multiple components, targets, and pathways on the anti-BRCA activity of P. vulgaris could provide a theoretical basis for further study on its complex anti-BRCA mechanism.