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Jiang QH, Hu H, Xu ZH, Duan P, Li ZH, Tan JT. Impact of neoadjuvant chemotherapy on perioperative immune function in breast cancer patients: a propensity score-matched retrospective study. Sci Rep 2024; 14:18738. [PMID: 39134566 PMCID: PMC11319620 DOI: 10.1038/s41598-024-69546-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 08/06/2024] [Indexed: 08/15/2024] Open
Abstract
To evaluate the impact of neoadjuvant chemotherapy on perioperative immune function in breast cancer patients, focusing on CD3+, CD4+, CD8+, and natural killer (NK) cells, as well as the CD4+/CD8+ ratio. We retrospectively reviewed medical records of breast cancer patients who underwent surgery with or without neoadjuvant chemotherapy at our medical center from January 2020 to December 2022. Patients were matched 1:1 based on propensity scores. Immune cell proportions and the CD4+/CD8+ ratio were compared on preoperative day one and postoperative days one and seven. Among matched patients, immune cell proportions and the CD4+/CD8+ ratio did not significantly differ between those who received neoadjuvant chemotherapy and those who did not at any of the three time points. Similar results were observed in chemotherapy-sensitive patients compared to the entire group of patients who did not receive neoadjuvant chemotherapy. However, chemotherapy-insensitive patients had significantly lower proportions of CD4+ and NK cells, as well as a lower CD4+/CD8+ ratio, at all three time points compared to patients who did not receive neoadjuvant chemotherapy. Neoadjuvant chemotherapy may impair immune function in chemotherapy-insensitive patients, but not in those who are sensitive to the treatment.
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Affiliation(s)
- Qi-Hua Jiang
- Department of Breast Surgery, The Third Hospital of Nanchang, No. 2, Xiangshan South Road, Xi hu District, Nanchang City, 330008, Jiangxi Province, China
| | - Hai Hu
- Department of Breast Surgery, The Third Hospital of Nanchang, No. 2, Xiangshan South Road, Xi hu District, Nanchang City, 330008, Jiangxi Province, China
- Department of General Surgery, The Third Hospital of Nanchang, Nanchang City, 330008, China
| | - Zhi-Hong Xu
- Department of Breast Surgery, The Third Hospital of Nanchang, No. 2, Xiangshan South Road, Xi hu District, Nanchang City, 330008, Jiangxi Province, China
| | - Peng Duan
- Jiangxi Province Key Laboratory of Breast Diseases, The Third Hospital of Nanchang, Nanchang City, 330008, China.
- Department of Endocrinology, The Third Hospital of Nanchang, No. 2, Xiangshan South Road, Xihu District, Nanchang City, 330008, Jiangxi Province, China.
| | - Zhi-Hua Li
- Department of Breast Surgery, The Third Hospital of Nanchang, No. 2, Xiangshan South Road, Xi hu District, Nanchang City, 330008, Jiangxi Province, China.
- Jiangxi Province Key Laboratory of Breast Diseases, The Third Hospital of Nanchang, Nanchang City, 330008, China.
| | - Jun-Tao Tan
- Department of Breast Surgery, The Third Hospital of Nanchang, No. 2, Xiangshan South Road, Xi hu District, Nanchang City, 330008, Jiangxi Province, China.
- Jiangxi Province Key Laboratory of Breast Diseases, The Third Hospital of Nanchang, Nanchang City, 330008, China.
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Schiavone A, Ventimiglia F, Zarba Meli E, Taffurelli M, Caruso F, Gentilini OD, Del Mastro L, Livi L, Castellano I, Bernardi D, Minelli M, Fortunato L. Third national surgical consensus conference of the Italian Association of Breast Surgeons (ANISC) on management after neoadjuvant chemotherapy: The difficulty in reaching a consensus. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108351. [PMID: 38701582 DOI: 10.1016/j.ejso.2024.108351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/15/2024] [Accepted: 04/15/2024] [Indexed: 05/05/2024]
Abstract
INTRODUCTION Neoadjuvant chemotherapy (NAC) has a profound impact on surgical management of breast cancer. For this reason, the Italian Association of Breast Surgeons (ANISC) promoted the third national Consensus Conference on this subject, open to multidisciplinary specialists. MATERIALS AND METHODS The Consensus Conference was held on-line in November 2022, and after an introductory session with five core-team experts, participants were asked to vote on eleven controversial issues, while results were collected in real-time with a polling system. RESULTS A total of 164 dedicated specialists from 74 Breast Centers participated. Consensus was reached for only three of the eleven issues, including: 1) the indication to assess the response with Magnetic Resonance Imaging (79 %); 2) the need to re-assess the biological factors of the residual tumor if present (96 %); 3) the possibility of omitting a formal axillary node dissection for cN1 patients if a pathologic Complete Response (pCR) was confirmed with analysis of one or more sentinel lymph nodes (82 %). The majority voted in favor of mapping both the breast and nodal lesions pre-NAC (59 %), and against the omission of sentinel lymph node biopsy in cN0 patients in the case of pathologic or clinical Complete Response (69 %). In cases of cT3/cN1+ tumors with pCR, only 8 % of participants considered appropriate the omission of Post-Mastectomy Radiation Therapy. CONCLUSION There is still a wide variability in surgical approaches after NAC in the "real world". As NAC is increasingly used, multidisciplinary teams should be attuned to conforming their procedures to the rapid advances in this field.
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Affiliation(s)
- Alfonso Schiavone
- Breast Center, San Giovanni-Addolorata Hospital, Via Dell'Amba Aradam 8, 00184, Rome, Italy; Department of Surgical Science, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy.
| | - Fabrizio Ventimiglia
- Breast Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Via Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Emanuele Zarba Meli
- Breast Center, San Giovanni-Addolorata Hospital, Via Dell'Amba Aradam 8, 00184, Rome, Italy
| | - Mario Taffurelli
- Breast Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Via Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Francesco Caruso
- Breast Unit, Humanitas Istituto Clinico Catanese, Contrada Cubba 11, SP54, 95045, Misterbianco, CT, Italy
| | | | - Lucia Del Mastro
- Breast Unit, IRCCS Ospedale Policlinico San Martino, Department of Internal Medicine and Medical Specialties (DIMI), Largo Rosanna Benzi 10, 16132, Genova, Italy
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, P.zza San Marco 4, 50121, Florence, Italy
| | - Isabella Castellano
- Pathology Unit, Department of Medical Sciences, University of Turin, Via Giuseppe Verdi 8, 10124, Turin, Italy
| | - Daniela Bernardi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Mauro Minelli
- Breast Center, San Giovanni-Addolorata Hospital, Via Dell'Amba Aradam 8, 00184, Rome, Italy
| | - Lucio Fortunato
- Breast Center, San Giovanni-Addolorata Hospital, Via Dell'Amba Aradam 8, 00184, Rome, Italy
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Nikmanesh N, Hosseini S, Mirbagheri F, Asadsangabi K, Fattahi MR, Safarpour AR, Abarghooee EF, Moravej A, Shamsdin SA, Akrami H, Saghi SA, Nikmanesh Y. Knowledge on Human Papillomavirus Infections, Cancer Biology, Immune Interactions, Vaccination Coverage and Common Treatments: A Comprehensive Review. Viral Immunol 2024; 37:221-239. [PMID: 38841885 DOI: 10.1089/vim.2023.0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Abstract
Human papillomavirus (HPV) is a circular, double-stranded DNA virus and recognized as the most prevalent sexually transmitted infectious agent worldwide. The HPV life cycle encompasses three primary stages. First, the virus infiltrates the basal cells of the stratified epidermis. Second, there is a low-level expression of viral genes and preservation of the viral genome in the basal layer. Lastly, productive replication of HPV occurs in differentiated cells. An effective immune response, involving various immune cells, including innate immunity, keratinocytes, dendritic cells, and natural killer T cells, is instrumental in clearing HPV infection and thwarting the development of HPV-associated tumors. Vaccines have demonstrated their efficacy in preventing genital warts, high-grade precancerous lesions, and cancers in females. In males, the vaccines can also aid in preventing genital warts, anal precancerous lesions, and cancer. This comprehensive review aims to provide a thorough and detailed exploration of HPV infections, delving into its genetic characteristics, life cycle, pathogenesis, and the role of high-risk and low-risk HPV strains. In addition, this review seeks to elucidate the intricate immune interactions that govern HPV infections, spanning from innate immunity to adaptive immune responses, as well as examining the evasion mechanisms used by the virus. Furthermore, the article discusses the current landscape of HPV vaccines and common treatments, contributing to a holistic understanding of HPV and its associated diseases.
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Affiliation(s)
- Nika Nikmanesh
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - SeyedehZahra Hosseini
- Department of Biological Science, Faculty of Science, University of Kurdistan, Sanandaj, Iran
| | | | - Kimiya Asadsangabi
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Reza Fattahi
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Reza Safarpour
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Ali Moravej
- Department of Laboratory Sciences, School of Allied Medical Sciences, Fasa University of Medical Science, Fasa, Iran
| | - Seyedeh Azra Shamsdin
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hassan Akrami
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyyed Amirreza Saghi
- Cellular and Molecular Biology Research Center, Larestan University of Medical Sciences, Larestan, Iran
- Student Research Committee, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Yousef Nikmanesh
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Choi JM, Lee JK, Pyon JK, Mun GH, Jeon BJ, Lee KT. Association of Neoadjuvant Chemotherapy With Postoperative Outcomes in Immediate Prepectoral Prosthetic Breast Reconstruction. Ann Plast Surg 2024; 92:514-521. [PMID: 38685491 DOI: 10.1097/sap.0000000000003887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
PURPOSE Neoadjuvant chemotherapy (NACT) followed by total mastectomy and immediate reconstruction has become an important strategy in the treatment of breast cancer. Although the safety of subpectoral implant-based breast reconstruction with NACT has been extensively evaluated, the safety in prepectoral reconstruction has not been clearly elucidated. We aimed to evaluate the association of NACT with immediate prepectoral breast reconstruction outcomes. METHODS A retrospective review of patients who underwent total mastectomy and immediate implant-based prepectoral breast reconstruction between May and December 2021 was conducted. Patients were categorized into 2 groups: those receiving NACT and those not receiving it. Postoperative complication rates were compared between the 2 groups. The independent association between NACT and the complication profiles was evaluated. Propensity score matching was also conducted. RESULTS We analyzed 343 cases, including 85 who received NACT treatment and 258 who did not. Compared with the non-NACT group, the NACT group was younger, had a higher body mass index, and a higher rate of adjuvant radiotherapy. There were no differences in the rates of overall complications or type of complication between the 2 groups. In the multivariable logistic analyses, NACT did not show a significant association with the development of adverse outcomes. Similar results were observed in propensity score matching analyses. CONCLUSIONS Our results suggest that receiving NACT may not have a significant detrimental effect on the postoperative outcomes of immediate prepectoral prosthetic reconstructions. Conducting prepectoral implant-based reconstruction in the setting of NACT might be safe and provide acceptable outcomes.
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Affiliation(s)
- Jae-Min Choi
- From the Department of Plastic and Reconstructive Surgery, Myong-Ji Hospital, Myong-Ji Medical Foundation, Goyang
| | - Jong-Koo Lee
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jai-Kyong Pyon
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Goo-Hyun Mun
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Byung-Joon Jeon
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyeong-Tae Lee
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Nogi H, Ogiya A, Ishitobi M, Yamauchi C, Mori H, Shimo A, Narui K, Nagura N, Seki H, Sasada S, Sakurai T, Shien T. Impact of neoadjuvant chemotherapy on the safety and long-term outcomes of patients undergoing immediate breast reconstruction after mastectomy. Breast Cancer 2024; 31:507-518. [PMID: 38573438 PMCID: PMC11045575 DOI: 10.1007/s12282-024-01570-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/08/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND In breast cancer patients receiving neoadjuvant chemotherapy (NAC), immediate breast reconstruction (IBR) as a breast cancer treatment option remains controversial. We assessed the impact of NAC on surgical and oncological outcomes of patients undergoing IBR. METHODS This was a retrospective multicenter study of 4726 breast cancer cases undergoing IBR. The rate of postoperative complications and survival data were compared between IBR patients who received NAC and those who did not receive NAC. Propensity score matching analysis was performed to mitigate selection bias for survival. RESULTS Of the total 4726 cases, 473 (10.0%) received NAC. Out of the cases with NAC, 96 (20.3%) experienced postoperative complications, while 744 cases (17.5%) without NAC had postoperative complications. NAC did not significant increase the risk of complications after IBR (Odds ratio, 0.96; 95%CI 0.74-1.25). At the median follow-up time of 76.5 months, 36 patients in the NAC group and 147 patients in the control group developed local recurrences. The 5-year local recurrence-free survival rate was 93.1% in the NAC group and 97.1% in the control group. (P < 0.001). After matching, there was no significant difference between the two groups. CONCLUSION IBR after NAC is a safe procedure with an acceptable postoperative complication profile.
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Affiliation(s)
- Hiroko Nogi
- Department of Breast and Endocrine Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minto-Ku, Tokyo, 105-8461, Japan.
| | - Akiko Ogiya
- Department of Breast Surgical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
- Department of Breast Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Makoto Ishitobi
- Department of Breast Surgery, Mie University School of Medicine, Mie, Japan
| | - Chikako Yamauchi
- Department of Radiation Oncology, Shiga General Hospital, Shiga, Japan
| | - Hiroki Mori
- Department of Plastic and Reconstructive Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ayaka Shimo
- Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Kazutaka Narui
- Department of Breast and Thyroid Surgery, Medical Center, Yokohama City University, Kanagawa, Japan
| | - Naomi Nagura
- Department of Breast Surgical Oncology, St Luke's International Hospital, Tokyo, Japan
| | - Hirohito Seki
- Department of Breast Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Shinsuke Sasada
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | | | - Tadahiko Shien
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
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Rogers C, Cobb AN, Lloren JIC, Chaudhary LN, Johnson MK, Huang CC, Teshome M, Kong AL, Singh P, Cortina CS. National trends in neoadjuvant chemotherapy utilization in patients with early-stage node-negative triple-negative breast cancer: the impact of the CREATE-X trial. Breast Cancer Res Treat 2024; 203:317-328. [PMID: 37864105 PMCID: PMC10872271 DOI: 10.1007/s10549-023-07114-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/24/2023] [Indexed: 10/22/2023]
Abstract
PURPOSE Neoadjuvant chemotherapy (NAC) for triple-negative breast cancer (TNBC) allows for assessment of tumor pathological response and has survival implications. In 2017, the CREATE-X trial demonstrated survival benefit with adjuvant capecitabine in patients TNBC and residual disease after NAC. We aimed to assess national rates of NAC for cT1-2N0M0 TNBC before and after CREATE-X and examine factors associated with receiving NAC vs adjuvant chemotherapy (AC). METHODS A retrospective cohort study of women with cT1-2N0M0 TNBC diagnosed from 2014 to 2019 in the National Cancer Database (NCDB) was performed. Variables were analyzed via ANOVA, Chi-squared, Fisher Exact tests, and a multivariate linear regression model was created. RESULTS 55,633 women were included: 26.9% received NAC, 52.4% AC, and 20.7% received no chemotherapy (median ages 53, 59, and 71 years, p < 0.01). NAC utilization significantly increased over time: 19.5% in 2014-15 (n = 3,465 of 17,777), 27.1% in 2016-17 (n = 5,140 of 18,985), and 33.6% in 2018-19 (n = 6,337 of 18,871, p < 0.001). On multivariate analysis, increased NAC was associated with younger age (< 50), non-Hispanic white race/ethnicity, lack of comorbidities, cT2 tumors, care at an academic or integrated-network cancer program, and diagnosis post-2017 (p < 0.05 for all). Patients with government-provided insurance were less likely to receive NAC (p < 0.01). Women who traveled > 60 miles for treatment were more likely to receive NAC (p < 0.01). CONCLUSION From 2014 to 2019, NAC utilization increased for patients with cT1-2N0M0 TNBC. Racial, socioeconomic, and access disparities were observed in who received NAC vs AC and warrants interventions to ensure equitable care.
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Affiliation(s)
- Christine Rogers
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
| | - Adrienne N Cobb
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
| | - Jan I C Lloren
- Zibler School of Public Health, University of Wisconsin at Milwaukee, Milwaukee, WI, USA
| | - Lubna N Chaudhary
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Medical College of Wisconsin Cancer Center, Milwaukee, WI, USA
| | - Morgan K Johnson
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
| | - Chiang-Ching Huang
- Zibler School of Public Health, University of Wisconsin at Milwaukee, Milwaukee, WI, USA
| | - Mediget Teshome
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amanda L Kong
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
- Medical College of Wisconsin Cancer Center, Milwaukee, WI, USA
| | - Puneet Singh
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chandler S Cortina
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA.
- Medical College of Wisconsin Cancer Center, Milwaukee, WI, USA.
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Turgeon MK, Willcox LM, Styblo TM, Losken A. Impact of Oncoplastic Surgery on Oncologic Outcomes in Patients with Breast Cancer. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5561. [PMID: 38292812 PMCID: PMC10827286 DOI: 10.1097/gox.0000000000005561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/27/2023] [Indexed: 02/01/2024]
Abstract
Background For patients with breast cancer, oncoplastic surgery (OPS) serves as a valuable technique that allows for immediate reconstruction at the time of resection. While the aim of OPS is to improve breast cosmesis, it is critical to ensure OPS does not negatively impact appropriate cancer treatment. Methods Based on current literature, this study provides a broad overview on the potential oncologic advantages of OPS for patients diagnosed with breast cancer. Results OPS has been shown to be a safe and reliable approach with oncologic advantages. More specifically, OPS broadens the indications for breast conservation therapy (BCT); allows for a more generous margin of resection, thus decreasing rates of re-excision; and provides the opportunity to sample additional breast tissue, which may detect occult disease. Reduction mammaplasty may also decrease the risk for developing breast cancer. Importantly, in the era of multimodality therapy, long-term oncologic outcomes and postoperative surveillance algorithms appear to be similar when comparing patients who undergo OPS and BCT. Conclusions For patients with breast cancer, oncoplastic surgery has emerged as a valuable technique to improve breast cosmesis while achieving optimal oncologic outcomes. As the landscape of breast oncology continues to evolve, it is critical for a multidisciplinary team to be involved to guide management and reconstructive strategies.
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Affiliation(s)
| | | | - Toncred M. Styblo
- Winship Cancer Institute, Division of Surgical Oncology, Department of Surgery, Emory University, Atlanta, Ga
| | - Albert Losken
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Emory University, Atlanta, Ga
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Sabitovic A, Trøstrup H, Damsgaard TE. The impact of neoadjuvant chemotherapy on surgical outcomes following autologous and implant-based immediate breast reconstruction: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2023; 87:17-23. [PMID: 37804643 DOI: 10.1016/j.bjps.2023.09.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/02/2023] [Accepted: 09/12/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND The impact of neoadjuvant chemotherapy (NACT) on the complication rate after implant-based and autologous breast reconstruction remains unclear. The aim of this study was to systematically review and perform a meta-analysis of previously published studies on immediate breast reconstruction (IBR) in breast cancer patients treated with NACT compared with controls. METHODS PubMed and EMBASE were searched to identify studies assessing the impact of NACT on major and minor complications after IBR. The primary effect measures were relative risk (RR), 95% confidence interval (95% CI), and p-value. RESULTS Eight studies comprising 51,731 patients were included in the meta-analysis. Of these, 5161 patients received NACT and 46,570 patients did not receive NACT. In regard to major complications, NACT did not statistically significant increase the rate of reconstructive failure (RR = 1.35, 95% CI = 0.96-1.91, p = 0.09), the rate of mastectomy skin-flap necrosis (RR = 1.39, 95% CI = 0.61-3.17, p = 0.44), or the rate of reoperation (RR = 1.09, 95% CI = 0.87-1.37, p = 0.45). Regarding minor complications, NACT did not significantly increase the rate of wound complications (RR = 1.05, 95% CI = 0.87-1.28, p = 0.62). In a subgroup analysis of implant-based breast reconstruction following NACT, single-stage direct-to-implant (DTI) had a significantly lower implant failure rate compared with two-staged tissue expander/implant (TE/I) (RR = 0.43, 95% CI = 0.26-0.71, p = 0.0011). CONCLUSION NACT did not increase the major or minor complication rate after IBR with either autologous tissue or implants. Thus, NACT and IBR should be considered safe procedures. The review of studies describing patients undergoing implant-based breast reconstruction following NACT could indicate that single-stage DTI was a safer procedure than two-staged TE/I. However, the association requires further evaluation.
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Affiliation(s)
- Ajla Sabitovic
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Hannah Trøstrup
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Tine Engberg Damsgaard
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
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Łazarczyk A, Streb J, Glajcar A, Streb-Smoleń A, Hałubiec P, Wcisło K, Laskowicz Ł, Hodorowicz-Zaniewska D, Szpor J. Dendritic Cell Subpopulations Are Associated with Prognostic Characteristics of Breast Cancer after Neoadjuvant Chemotherapy-An Observational Study. Int J Mol Sci 2023; 24:15817. [PMID: 37958800 PMCID: PMC10648319 DOI: 10.3390/ijms242115817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
Breast cancer (BC) is the most prevalent malignancy in women and researchers have strived to develop optimal strategies for its diagnosis and management. Neoadjuvant chemotherapy (NAC), which reduces tumor size, risk of metastasis and patient mortality, often also allows for a de-escalation of breast and axillary surgery. Nonetheless, complete pathological response (pCR) is achieved in no more than 40% of patients who underwent NAC. Dendritic cells (DCs) are professional antigen-presenting cells present in the tumor microenvironment. The multitude of their subtypes was shown to be associated with the pathological and clinical characteristics of BC, but it was not evaluated in BC tissue after NAC. We found that highe r densities of CD123+ plasmacytoid DCs (pDCs) were present in tumors that did not show pCR and had a higher residual cancer burden (RCB) score and class. They were of higher stage and grade and more frequently HER2-negative. The density of CD123+ pCDs was an independent predictor of pCR in the studied group. DC-LAMP+ mature DCs (mDCs) were also related to characteristics of clinical relevance (i.e., pCR, RCB, and nuclear grade), although no clear trends were identified. We conclude that CD123+ pDCs are candidates for a novel biomarker of BC response to NAC.
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Affiliation(s)
- Agnieszka Łazarczyk
- Department of Pathomorphology, Jagiellonian University Medical College, 31-501 Cracow, Poland (J.S.)
| | - Joanna Streb
- Department of Oncology, Jagiellonian University Medical College, 31-501 Cracow, Poland
- University Centre of Breast Disease, University Hospital, 31-501 Cracow, Poland
| | - Anna Glajcar
- Department of Pathomorphology, University Hospital, 30-688 Cracow, Poland
| | - Anna Streb-Smoleń
- Department of Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, 31-115 Cracow, Poland
| | - Przemysław Hałubiec
- Doctoral School of Medical and Health Sciences, Jagiellonian University Medical College, 31-530 Cracow, Poland
| | - Kacper Wcisło
- Department of Pathomorphology, Jagiellonian University Medical College, 31-501 Cracow, Poland (J.S.)
- Department of Pathomorphology, University Hospital, 30-688 Cracow, Poland
| | - Łukasz Laskowicz
- Clinical Department of Gynecology and Gynecological Oncology, University Hospital, 30-688 Cracow, Poland
| | - Diana Hodorowicz-Zaniewska
- General, Oncological and Gastrointestinal Surgery, Jagiellonian University Medical College, 31-501 Cracow, Poland;
- Department of General Surgery, University Hospital, 31-501 Cracow, Poland
| | - Joanna Szpor
- Department of Pathomorphology, Jagiellonian University Medical College, 31-501 Cracow, Poland (J.S.)
- University Centre of Breast Disease, University Hospital, 31-501 Cracow, Poland
- Department of Pathomorphology, University Hospital, 30-688 Cracow, Poland
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Nguyen LB, Vu LG, Le TT, Nguyen XT, Dao NG, Nguyen DC, Huyen Thi Dang T, Vu TMT, Boyer L, Fond G, Auquier P, Latkin CA, Zhang MWB, Ho RCM, Ho CSH. Impact of interventions on the quality of life of cancer patients: a systematic review and meta-analysis of longitudinal research. Health Qual Life Outcomes 2023; 21:112. [PMID: 37821985 PMCID: PMC10566122 DOI: 10.1186/s12955-023-02189-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 09/11/2023] [Indexed: 10/13/2023] Open
Abstract
The impact of cancer interventions has been conducted in several research due to the significant burden of this non-communicable disease. The interventions that played an important role in the improvement of the patient's quality of life (QoL) and health-related quality of life (HRQL) can be classified into two main groups: pharmaceutical and non-pharmacological methods. However, studies so far often analyze a specific group of interventions for specific types of cancer. Thus, in this systematic review and meta-analysis, we synthesized the overall impact of cancer interventions on patients' quality of life in several cancers.In this research, we followed the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) to search the longitudinal original research on the Web of Science (WOS) database. After that, the Newcastle-Ottawa Scale (NOS) and Jadad Scale were used to assess the quality of non-randomized control trials and randomized control trials, respectively. Then, the characteristics of the included studies were described in the six main fields table and the random effect model with robust estimation was applied to analyze the impact of interventions on the health utility of patients.From the database, 122 longitudinal original research were included in the meta-regression, with most of them having high or fair quality. The European Organization for the research and treatment of cancer scale for quality of life (EORTC-QLQ) was the most used health utility measurement at 65.15%. In the adjusted effect models, the Visual Analogue Scale (VAS) had significant statistics in all models when we compared it with the EQ-5D Scale (p < 0.05) and several types of cancer such as breast, lung, and prostate cancer had significant statistics when comparing with hematological cancer in the model types of cancer (p < 0.01). Moreover, radiotherapy, screening, and a combination of chemotherapy and best supportive care also had significant statistics (p < 0.01) in the model of interventions when compared with radiotherapy applied only. Our research can suggest a vital combination of both pharmaceutical and non-pharmacological interventions to improve the quality of life of some common types of cancer patients.
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Affiliation(s)
- Long Bao Nguyen
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, 100000, Vietnam
| | - Linh Gia Vu
- Institute for Global Health Innovations, Duy Tan University, 550000, Da Nang, Vietnam
- Faculty of Medicine, Duy Tan University, Da Nang, 550000, Vietnam
| | - Thanh Thien Le
- Department of Biomedical Engineering, Tufts University, 200 College Avenue, Medford, MA, 02155, USA
| | | | - Nam Gia Dao
- Institute for Global Health Innovations, Duy Tan University, 550000, Da Nang, Vietnam
- Faculty of Medicine, Duy Tan University, Da Nang, 550000, Vietnam
| | - Duy Cao Nguyen
- Institute for Global Health Innovations, Duy Tan University, 550000, Da Nang, Vietnam.
- Faculty of Medicine, Duy Tan University, Da Nang, 550000, Vietnam.
| | | | - Thuc Minh Thi Vu
- Institute of Health Economics and Technology (iHEAT), Hanoi, Vietnam
| | - Laurent Boyer
- Research Centre on Health Services and Quality of Life, Aix Marseille University, 27, boulevard Jean-Moulin, CEReSS, Marseille cedex 05, 3279, 13385, France
| | - Guillaume Fond
- Research Centre on Health Services and Quality of Life, Aix Marseille University, 27, boulevard Jean-Moulin, CEReSS, Marseille cedex 05, 3279, 13385, France
| | - Pascal Auquier
- Research Centre on Health Services and Quality of Life, Aix Marseille University, 27, boulevard Jean-Moulin, CEReSS, Marseille cedex 05, 3279, 13385, France
| | - Carl A Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Melvyn W B Zhang
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Roger C M Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, 119077, Singapore
| | - Cyrus S H Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
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Ossowska M, Picornell JA, Finotello R, Amores-Fuster I, Tanis JB. Pre-operative neoadjuvant vinblastine-prednisolone in canine mast cell tumours: A single-centre retrospective cohort study. Vet Comp Oncol 2023; 21:447-459. [PMID: 37183272 DOI: 10.1111/vco.12904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 05/16/2023]
Abstract
Neoadjuvant chemotherapy can be used in canine mast cell tumours (MCTs) to optimise surgical margins or to enable marginal excision in challenging locations. The objective of this study was to describe the outcome of dogs with cutaneous and subcutaneous MCTs treated with neoadjuvant vinblastine-prednisolone (NA-VP). Records of treatment-naïve dogs with cutaneous/subcutaneous MCT that received NA-VP were reviewed including signalment, indication for NA-VP, staging results, clinical response, surgical data and histopathology reports. For dogs with post-operative follow-up ≥365 days, predictive factors for local recurrence (LR) were evaluated. Forty-four dogs were included. NA-VP was indicated to optimise surgical margins (group MARG) in 19 dogs (43.2%) and to enable surgery (group MORB) in 25 dogs (56.8%). Complete and partial response were documented in 40.9% of dogs and 30 dogs (68.2%) underwent surgery. The indication for NA-VP was significantly associated with undergoing surgery (p < .001) on multivariable analysis. Twelve (48%) and 18 dogs (94.7%) underwent surgery in the group MORB and MARG, respectively. Five dogs (16.7%) experienced wound dehiscence. Complete excision was achieved in 14 dogs (46.7%). In dogs undergoing surgery with ≥365 days of follow-up, LR was documented in five cases (20.8%). None of the factors analysed including mitotic count, completeness of excision and response to NA-VP were associated with LR; notably, LR occurred in 3/11 (27.2%) completely excised MCTs. In a pre-operative setting, NA-VP appears safe and could be beneficial in selected cases. Prognostic factors such as clinical response, mitotic count and completeness of excision should be interpreted with caution following NA-VP.
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Affiliation(s)
- Małgorzata Ossowska
- Department of Small Animal Clinical Sciences, Institute of Veterinary Science, University of Liverpool, Neston, UK
| | - Jose Alvarez Picornell
- Department of Small Animal Clinical Sciences, Institute of Veterinary Science, University of Liverpool, Neston, UK
| | - Riccardo Finotello
- Department of Small Animal Clinical Sciences, Institute of Veterinary Science, University of Liverpool, Neston, UK
- Department of Veterinary Medicine, University of Bari, Valenzano, Italy
| | - Isabel Amores-Fuster
- Department of Small Animal Clinical Sciences, Institute of Veterinary Science, University of Liverpool, Neston, UK
| | - Jean-Benoit Tanis
- Department of Small Animal Clinical Sciences, Institute of Veterinary Science, University of Liverpool, Neston, UK
- Department of Molecular & Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
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12
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Robinson MD, McNamara MG, Clouston HW, Sutton PA, Hubner RA, Valle JW. Patients Undergoing Systemic Anti-Cancer Therapy Who Require Surgical Intervention: What Surgeons Need to Know. Cancers (Basel) 2023; 15:3781. [PMID: 37568597 PMCID: PMC10417541 DOI: 10.3390/cancers15153781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/15/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
As part of routine cancer care, patients may undergo elective surgery with the aim of long-term cure. Some of these patients will receive systemic anti-cancer therapy (SACT) in the neoadjuvant and adjuvant settings. The majority of patients, usually with locally advanced or metastatic disease, will receive SACT with palliative intent. These treatment options are expanding beyond traditional chemotherapy to include targeted therapies, immunotherapy, hormone therapy, radionuclide therapy and gene therapy. During treatment, some patients will require surgical intervention on an urgent or emergency basis. This narrative review examined the evidence base for SACT-associated surgical risk and the precautions that a surgical team should consider in patients undergoing SACT.
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Affiliation(s)
- Matthew D. Robinson
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester M13 9NT, UK
| | - Mairéad G. McNamara
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester M13 9NT, UK
- Department of Medical Oncology, ENETS Centre of Excellence, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
| | - Hamish W. Clouston
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester M13 9NT, UK
- Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
| | - Paul A. Sutton
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester M13 9NT, UK
- Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
| | - Richard A. Hubner
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester M13 9NT, UK
- Department of Medical Oncology, ENETS Centre of Excellence, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
| | - Juan W. Valle
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester M13 9NT, UK
- Department of Medical Oncology, ENETS Centre of Excellence, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
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Seth I, Bulloch G, Jennings M, Seth N, Gracias D, Hunter-Smith DJ, Rozen WM. The effect of chemotherapy on the complication rates of breast reconstruction: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2023; 82:186-197. [PMID: 37182249 DOI: 10.1016/j.bjps.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 04/11/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND The impact of chemotherapy on complications following breast reconstruction surgery (BRS) is currently inconclusive. This meta-analysis investigates the impact of chemotherapy on complication rates in BRS. METHODS Preferred Reporting in Systematic Review and Meta-Analysis (PRISMA) guidelines was used to search relevant studies published from January 2006 to March 2022. The complication rates of neoadjuvant systemic therapy (NST) and adjuvant systemic therapy (AST) were analyzed via RevMan software 5.4, and a P value of< 0.05 was considered significant. The quality of selected studies was performed using the Newcastle-Ottawa scale for quality assessment. RESULTS A total of 18 studies comprising 49,217 patients were included. There was no significant difference in the total complications rate, major complications, or minor complications between NST and BRS or control. The rate of wound dehiscence was higher in the NST group compared with the BRS only group [RR= 1.54, 95% CI, (1.08, 2.18), P = 0.02], and the rate of infection was lower in the NST group compared with the BRS only group, [RR= 0.75, 95% CI, (0.61, 0.94), P = 0.01]. No significant difference in the rates of hematoma, seroma, skin necrosis, and implant loss was detected between NST and AST, or NST with BRS only. No statistically significant differences in total complication rates were observed between flap and implant BRS types (P = 0.88). CONCLUSION No significant differences between AST and NST were detected for complications. Significantly, NST had more wound dehiscence and less infection rates compared with BRS only groups, possibly reflecting selection bias or issues in the design of reported studies. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Ishith Seth
- Department of Surgery, Bendigo Health, Bendigo, Victoria 3550, Australia; Faculty of Science, Medicine, and Health, University of Melbourne, Victoria 3010, Australia; Peninsula Clinical School, Central Clinical School at Monash University, The Alfred Centre, 99 Commercial Rd, Melbourne, Victoria 3004, Australia.
| | - Gabriella Bulloch
- Faculty of Science, Medicine, and Health, University of Melbourne, Victoria 3010, Australia
| | - Matthew Jennings
- Department of Surgery, Bendigo Health, Bendigo, Victoria 3550, Australia
| | - Nimish Seth
- Department of Surgery, The Alfred Hospital, Melbourne, Victoria 3004, Australia
| | - Dylan Gracias
- Department of Surgery, Bendigo Health, Bendigo, Victoria 3550, Australia
| | - David J Hunter-Smith
- Peninsula Clinical School, Central Clinical School at Monash University, The Alfred Centre, 99 Commercial Rd, Melbourne, Victoria 3004, Australia
| | - Warren M Rozen
- Peninsula Clinical School, Central Clinical School at Monash University, The Alfred Centre, 99 Commercial Rd, Melbourne, Victoria 3004, Australia
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Tiwari H, Rai N, Singh S, Gupta P, Verma A, Singh AK, Kajal, Salvi P, Singh SK, Gautam V. Recent Advances in Nanomaterials-Based Targeted Drug Delivery for Preclinical Cancer Diagnosis and Therapeutics. Bioengineering (Basel) 2023; 10:760. [PMID: 37508788 PMCID: PMC10376516 DOI: 10.3390/bioengineering10070760] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/20/2023] [Accepted: 06/23/2023] [Indexed: 07/30/2023] Open
Abstract
Nano-oncology is a branch of biomedical research and engineering that focuses on using nanotechnology in cancer diagnosis and treatment. Nanomaterials are extensively employed in the field of oncology because of their minute size and ultra-specificity. A wide range of nanocarriers, such as dendrimers, micelles, PEGylated liposomes, and polymeric nanoparticles are used to facilitate the efficient transport of anti-cancer drugs at the target tumor site. Real-time labeling and monitoring of cancer cells using quantum dots is essential for determining the level of therapy needed for treatment. The drug is targeted to the tumor site either by passive or active means. Passive targeting makes use of the tumor microenvironment and enhanced permeability and retention effect, while active targeting involves the use of ligand-coated nanoparticles. Nanotechnology is being used to diagnose the early stage of cancer by detecting cancer-specific biomarkers using tumor imaging. The implication of nanotechnology in cancer therapy employs photoinduced nanosensitizers, reverse multidrug resistance, and enabling efficient delivery of CRISPR/Cas9 and RNA molecules for therapeutic applications. However, despite recent advancements in nano-oncology, there is a need to delve deeper into the domain of designing and applying nanoparticles for improved cancer diagnostics.
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Affiliation(s)
- Harshita Tiwari
- Centre of Experimental Medicine and Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India
- Department of Botany, Institute of Science, Banaras Hindu University, Varanasi 221005, India
| | - Nilesh Rai
- Centre of Experimental Medicine and Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India
| | - Swati Singh
- Centre of Experimental Medicine and Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India
| | - Priyamvada Gupta
- Centre of Experimental Medicine and Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India
| | - Ashish Verma
- Centre of Experimental Medicine and Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India
| | - Akhilesh Kumar Singh
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India
| | - Kajal
- Department of Agriculture Biotechnology, National Agri-Food Biotechnology Institute, Sahibzada Ajit Singh Nagar 140306, India
| | - Prafull Salvi
- Department of Agriculture Biotechnology, National Agri-Food Biotechnology Institute, Sahibzada Ajit Singh Nagar 140306, India
| | - Santosh Kumar Singh
- Centre of Experimental Medicine and Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India
| | - Vibhav Gautam
- Centre of Experimental Medicine and Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India
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15
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Cook P, Yin G, Ayeni FE, Eslick GD, Edirimanne S. Does Immediate Breast Reconstruction Lead to a Delay in Adjuvant Chemotherapy for Breast Cancer? A Meta-Analysis and Systematic Review. Clin Breast Cancer 2023:S1526-8209(23)00083-6. [PMID: 37127453 DOI: 10.1016/j.clbc.2023.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 02/01/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023]
Abstract
Timely delivery of adjuvant chemotherapy is crucial. With an increasing frequency of immediate breast reconstructions (IBR) following mastectomy (MAS), concerns have arisen regarding its complication rates and effects on time to chemotherapy. The aim was to conduct a systematic review and meta-analysis to determine if there is a prolonged time to chemotherapy (TTC) after IBR and MAS. Electronic databases, reference lists and relevant articles were searched systematically. Eligibility criteria included women receiving adjuvant chemotherapy who underwent either MAS only or MAS and IBR. Random-effects models were used in the analysis. A total of 29 studies were included in qualitative analysis, comprising of 156,000 patients (IBR: 57,159; MAS: 98,841). But 23 studies had sufficient data to be included in the meta-analysis. Sixteen papers concluded there was no difference in TTC compared to MAS. There was a difference of 3.50 days between TTC in IBR versus MAS (95% CI [0.42, 6.57], P value = .0256; IBR = 43.56 days, MAS = 40.38 days). The rate of patients being delayed past 90 days was not significantly higher in IBR (OR = 1.34, 95% CI [0.76, 2.38], P = .310). IBR patients were more likely to have complications compared to the MAS group (OR = 2.04, 95% CI [1.04-4.01], P < .01). We concluded that there is a statistically significant longer time to chemotherapy following IBR of 3.50 days, yet there is no difference in delays past 90 days. Therefore, the longer TTC in IBR is unlikely to be of any clinical significance.
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Zijlker LP, van der Burg SJC, Blank CU, Zuur CL, Klop WMC, Wouters MWMJ, van Houdt WJ, van Akkooi ACJ. Surgical outcomes of lymph node dissections for stage III melanoma after neoadjuvant systemic therapy are not inferior to upfront surgery. Eur J Cancer 2023; 185:131-138. [PMID: 36989829 DOI: 10.1016/j.ejca.2023.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Neoadjuvant systemic therapy has shown promising results in the treatment of high-risk stage III melanoma; however, the effects on surgery are currently unknown. This study aims to compare the surgical outcomes, in terms of postoperative complications, postoperative morbidity, duration of surgery and textbook outcomes, of patients with high-risk stage III melanoma who received neoadjuvant systemic therapy followed by lymph node dissection with patients who received an upfront lymph node dissection. METHODS In this retrospective cohort study, patients with high-risk stage III melanoma treated with neoadjuvant anti-PD1 and anti-CTLA4 in the OpACIN (NCT02437279) and OpACIN-neo (NCT02977052) trial between October 2014 and August 2018 were included and compared to patients who received upfront surgery in the same time period. RESULTS A total of 120 patients were included in this study, of whom 44 received neoadjuvant systemic therapy and 76 underwent upfront surgery. There was no significant difference in the overall rate of postoperative complications between the neoadjuvant group and the upfront surgery group (31.8% versus 36.8%, p = 0.578) and neither in rate of postoperative morbidity (seroma 56.8% versus 57.9%, p = 0.908) (lymphedema 22.7% versus 13.2%, p = 0.175). There was a non-significant difference towards a slightly longer duration of surgery after neoadjuvant immunotherapy (105 versus 90 min, p = 0.077). There were no differences in textbook outcomes (50% versus 49%, p = 0.889). CONCLUSION This study shows that the surgical outcomes for patients who underwent a lymph node dissection after neoadjuvant systemic immunotherapy or underwent upfront lymph node dissection for high-risk stage III melanoma are comparable.
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Affiliation(s)
- Lisanne P Zijlker
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek (NKI-AVL), Amsterdam, the Netherlands; Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Stijn J C van der Burg
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek (NKI-AVL), Amsterdam, the Netherlands
| | - Christian U Blank
- Department of Medical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek (NKI-AVL), Amsterdam, the Netherlands
| | - Charlotte L Zuur
- Department of Head and Neck Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek (NKI-AVL), Amsterdam, the Netherlands; Department of Otorhinolaryngology Head and Neck Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - W Martin C Klop
- Department of Head and Neck Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek (NKI-AVL), Amsterdam, the Netherlands
| | - Michel W M J Wouters
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek (NKI-AVL), Amsterdam, the Netherlands; Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Winan J van Houdt
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek (NKI-AVL), Amsterdam, the Netherlands
| | - Alexander C J van Akkooi
- Melanoma Institute Australia, The University of Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Royal Prince Alfred Hospital, Sydney, NSW, Australia.
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Acea-Nebril B, García-Novoa A, Cereijo-Garea C, Conde Iglesias C, Bouzón Alejandro A, Díaz Carballada C. Safety and Quality of Life in Women with Immediate Reconstruction with Polyurethane Implants after Neoadjuvant Chemotherapy: Outcomes from The Preq-20 Trial. Cancers (Basel) 2023; 15:cancers15041113. [PMID: 36831457 PMCID: PMC9954288 DOI: 10.3390/cancers15041113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023] Open
Abstract
INTRODUCTION Various studies have evaluated the impact of neoadjuvant chemotherapy (NAC) on the complications of breast cancer surgery, most of which were retrospective and did not assess the variables related to postoperative risk factors. The aim of this study is to analyse the safety and satisfaction of women included in the PreQ-20 trial who underwent NAC and who underwent mastectomy and immediate reconstruction with prepectoral polyurethane implants. MATERIAL AND METHODS The patients included in the study belong to the prospective study PreQ-20. The study group consisted of patients who underwent immediate reconstruction after primary systemic therapy. The control groups consisted of patients with immediate reconstruction and adjuvant chemotherapy (control group 1) and patients with an infiltrating carcinoma or in situ ductal carcinoma who did not require chemotherapy (control group 2). RESULTS The study included 157 women, 58 (36.9%) of whom underwent primary systemic therapy. The indication for genetic study was significantly greater for the study group (87.9%) than for control groups 1 (49.1%) or 2 (30.4%). Seventy-two (45.9%) of the patients underwent bilateral mastectomy (BM), a procedure that was performed significantly more frequently in the study group (69%) than in control groups 1 (30.2%) or 2 (34.8%). The incidence rate for BM after complete pathologic response was 78%. There were no statistically significant differences in the number of complications between the groups. Implant loss was significantly more frequent in control group 1 (13.2%) than in the study group (3.4%) and control group 2 (2.2%). CONCLUSIONS Mastectomy with prepectoral polyurethane implant reconstruction in patients with neoadjuvant chemotherapy presented a similar incidence of complications compared with patients who underwent primary surgery. There is a high rate of BM in women with NAC.
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Affiliation(s)
- Benigno Acea-Nebril
- Breast Unit, Department of General Surgery, University Hospital Complex A Coruña, 15006 A Coruña, Spain
| | - Alejandra García-Novoa
- Breast Unit, Department of General Surgery, University Hospital Complex A Coruña, 15006 A Coruña, Spain
- Correspondence: ; Tel.: +34-674089387
| | | | - Carmen Conde Iglesias
- Breast Unit, Ginecology Service, University Hospital Complex A Coruña, 15006 A Coruña, Spain
| | - Alberto Bouzón Alejandro
- Breast Unit, Department of General Surgery, University Hospital Complex A Coruña, 15006 A Coruña, Spain
| | - Carlota Díaz Carballada
- Breast Unit, Ginecology Service, University Hospital Complex A Coruña, 15006 A Coruña, Spain
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18
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Impact of Surgical Care Bundle on Surgical Site Infection after Non-Reconstructive Breast Cancer Surgery: A Single-Centre Retrospective Comparative Cohort Study. Cancers (Basel) 2023; 15:cancers15030919. [PMID: 36765876 PMCID: PMC9913200 DOI: 10.3390/cancers15030919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 01/31/2023] [Accepted: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Surgical-site infections (SSIs) are the commonest cause of healthcare-related infections. Although a surgical care bundle (SCB), defined as a group of preventative measures, is effective in reducing SSIs, it has not been well documented in breast cancer surgery. We aimed to investigate the impact of SCB on SSI. METHODS A single-centre retrospective comparative cohort study between 2016 and 2020 was carried out. An SCB including eight different measures was implemented in October 2018 at Sahlgrenska University Hospital, Sweden. Patients who underwent non-reconstructive breast cancer surgery were included for analysis. The primary endpoint was SSI within 30 days after surgery. RESULTS Overall, 10.4% of patients (100/958) developed SSI. After SCB implementation, the overall SSI rate reduced from 11.8% to 8.9% (p = 0.15). The largest SSI rate reduction was seen in the subgroup that underwent breast conservation and sentinel lymph node biopsy (SLNB), from 18.8% to 9.8% (p = 0.01). In this multivariable analysis adjusting for patient and treatment factors, the implementation of SCB resulted in a statistically significant reduction in SSI risk (OR 0.63, 95% CI 0.40-0.99, p = 0.04). CONCLUSIONS The implementation of a SCB could reduce the incidence of SSI in breast cancer surgery.
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Muacevic A, Adler JR, Coelho G, Andresen C, Cardoso A, Costa H. Therapeutic Reduction Mammoplasty: Experience of a Single Institute. Cureus 2023; 15:e33603. [PMID: 36779121 PMCID: PMC9910390 DOI: 10.7759/cureus.33603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Breast cancer is the most common malignancy in women worldwide as reported by the World Health Organization. The concept of oncoplastic breast surgery appeared as an extension of breast-conserving surgery, applying breast reduction techniques with more acceptable aesthetic and functional outcomes. The purpose of the present study was to describe the breast cancer population of a single institute submitted to lumpectomy and bilateral immediate breast reduction or mastopexy and its complications. MATERIAL AND METHODS This is a retrospective observational study including patients submitted to lumpectomy and immediate bilateral breast reduction or mastopexy. Patients and tumour characteristics, surgical technique, complications, follow-up period, and recurrence data were obtained and analyzed. RESULTS A total of 49 patients were submitted to lumpectomy and bilateral breast therapeutic reduction/mastopexy, with a mean age of 56.47 ±8.58 years and a mean body mass index of 28.68kg/m2 ±3.94 kg/m² between January 2019 and December 2021. Invasive tumours of no specific type, associated or not, with carcinoma intraductal in situ were the most common histological type corresponding to almost 80% of the cases with T1 stage corresponding to more than half of the cases. Sixteen percent of the patients had early minor complications with wound dehiscence associated with wound delayed healing, corresponding to 75% of the cases. Body mass index had a statistical difference between groups (p=0,006, t-test). CONCLUSIONS The low rates of minor and major complications show that immediate therapeutic breast reduction can be a suitable approach in selected cases.
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Nussbaumer RL, Maggi N, Castrezana L, Zehnpfennig L, Schwab FD, Krol J, Oberhauser I, Weber WP, Kurzeder C, Haug MD, Kappos EA. The impact of neoadjuvant systemic treatment on postoperative complications in breast cancer surgery. Breast Cancer Res Treat 2023; 197:333-341. [PMID: 36403182 PMCID: PMC9823081 DOI: 10.1007/s10549-022-06811-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/09/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE The aim of the study was to analyze the impact of neoadjuvant systemic treatment (NST) on postoperative complications and the beginning of adjuvant treatment. METHODS This study includes data from a prospectively maintained database including patients with breast cancer (BC) stage I-IV with or without NST undergoing breast cancer surgery between January 2010 and September 2021. RESULTS Out of 517 enrolled patients, 77 received NST, 440 had primary breast surgery. After NST patients underwent surgery after a meantime of 34 days (26.5-40 days). No statistical significance could be found comparing the complication grading according to the Clavien Dindo classification. The complications were most frequently rated as grade 3b. There were no complications with grade 4 or higher. When differentiating into short and long-term, the overall rate of short-term complications was 20.3% with no significant difference between the two groups (20.8% vs. 20.2%). Regarding long-term complications, there was more impairment of shoulder mobility (26.0% vs. 9.5%, p ≤ 0.001) and chronic pain (42.9% vs. 28.6%, p ≤ 0.016) for patients with NST. The beginning of the administration of the adjuvant treatment was comparable in both groups (46.3 days vs. 50.5 days). CONCLUSION In our cohort, complications between both groups were comparable according to Clavien Dindo. This study shows that NST has no negative impact on postoperative short-term complications and most importantly did not lead to a delay of the beginning of adjuvant treatment. Therefore, NST can be safely admitted, even when followed by extensive breast reconstruction surgery.
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Affiliation(s)
- R. L. Nussbaumer
- grid.410567.1Department of Obstetrics and Gynecology, University Hospital of Basel, Basel, Switzerland ,grid.410567.1Breast Center, University Hospital of Basel, Basel, Switzerland
| | - N. Maggi
- grid.410567.1Breast Center, University Hospital of Basel, Basel, Switzerland
| | - L. Castrezana
- grid.410567.1Breast Center, University Hospital of Basel, Basel, Switzerland
| | - L. Zehnpfennig
- grid.6612.30000 0004 1937 0642University of Basel, Basel, Switzerland
| | - F. D. Schwab
- grid.410567.1Department of Obstetrics and Gynecology, University Hospital of Basel, Basel, Switzerland ,grid.410567.1Breast Center, University Hospital of Basel, Basel, Switzerland ,grid.6612.30000 0004 1937 0642University of Basel, Basel, Switzerland
| | - J. Krol
- grid.410567.1Breast Center, University Hospital of Basel, Basel, Switzerland
| | - I. Oberhauser
- grid.410567.1Breast Center, University Hospital of Basel, Basel, Switzerland
| | - W. P. Weber
- grid.410567.1Breast Center, University Hospital of Basel, Basel, Switzerland ,grid.6612.30000 0004 1937 0642University of Basel, Basel, Switzerland
| | - C. Kurzeder
- grid.410567.1Department of Obstetrics and Gynecology, University Hospital of Basel, Basel, Switzerland ,grid.410567.1Breast Center, University Hospital of Basel, Basel, Switzerland ,grid.6612.30000 0004 1937 0642University of Basel, Basel, Switzerland
| | - M. D. Haug
- grid.410567.1Breast Center, University Hospital of Basel, Basel, Switzerland ,grid.6612.30000 0004 1937 0642University of Basel, Basel, Switzerland ,grid.410567.1Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Basel, Switzerland
| | - Elisabeth A. Kappos
- grid.410567.1Breast Center, University Hospital of Basel, Basel, Switzerland ,grid.6612.30000 0004 1937 0642University of Basel, Basel, Switzerland ,grid.410567.1Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Basel, Switzerland
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21
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Jin J, Liu YH, Zhang B. Diagnostic Performance of Strain and Shear Wave Elastography for the Response to Neoadjuvant Chemotherapy in Breast Cancer Patients: Systematic Review and Meta-Analysis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2459-2466. [PMID: 34967455 DOI: 10.1002/jum.15930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/09/2021] [Accepted: 12/11/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To investigate the diagnostic performance of strain and shear wave elastography for the response to neoadjuvant chemotherapy (NAC) in breast cancer patients. METHODS Relevant studies were searched in the databases of PubMed, Web of Science and Cochrane Library until October 2021. The diagnostic performance of ultrasonic elastography for the response to NAC were estimated by calculating the area under the curve (AUC) with sensitivity and specificity using Stata 14.0. RESULTS A total of 15 studies that comprise 1147 breast cancer patients were included in this meta-analysis. The pooled AUC of strain elastography in diagnosing responses were 0.89 (95% CI = 0.86-0.91) with 87% (95% CI = 75-94%) of sensitivity and 80% (95% CI = 72-84%) of specificity. The pooled AUC of shear wave elastography in diagnosing response were 0.82 (95% CI = 0.78-0.85) with 79% (95% CI = 72-84%) of sensitivity and 81% (95% CI = 71-88%). No publication bias was observed across the studies using Deek's funnel plot. CONCLUSIONS Based on current evidence, this meta-analysis confirmed that strain and shear wave elastography exhibited favorable performance for predicting responses to NAC. Strain and shear wave elastography may be a useful, noninvasive method for the assessment of response to NAC in breast cancer patients.
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Affiliation(s)
- Jian Jin
- The Fourth Department of Thyroid and Breast Surgery, Cangzhou Central Hospital, Cangzhou City, China
| | - Yong Hong Liu
- The Fourth Department of Thyroid and Breast Surgery, Cangzhou Central Hospital, Cangzhou City, China
| | - Bo Zhang
- The Fourth Department of Thyroid and Breast Surgery, Cangzhou Central Hospital, Cangzhou City, China
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22
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Zhang H, Barner JC, Moczygemba LR, Rascati KL, Park C, Kodali D. Neoadjuvant chemotherapy use trends among older women with breast cancer: 2010-2017. Breast Cancer Res Treat 2022; 193:695-705. [PMID: 35449473 DOI: 10.1007/s10549-022-06604-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 04/06/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE This study assessed chemotherapy use trends before (neoadjuvant chemotherapy [NAC]) or after surgery (adjuvant chemotherapy [AdC]) among older women with breast cancer and examined factors related to NAC receipt. METHODS Women (> 65 years) diagnosed with stage I-III breast cancer during 2010-2017 who received NAC or AdC were identified from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. All patients were stratified into six strata based on subtype (hormone receptor-positive/human epidermal growth factor receptor 2-negative [HR + /HER2-], HER2 + , and triple-negative breast cancer [TNBC]) and stage (I-II and III). Cochran-Armitage tests were performed to test temporal trends of NAC use in each stratum. Multivariable logistic regression analyses were performed to identify factors (sociodemographic and clinical) related to NAC use. RESULTS Among included older (mean ± standard deviation: 72.3 ± 5.2 years) women (N = 8,495) with stage I-III breast cancer, NAC use increased from 11.7% (2010) to 32.6% (2017). Significant increases in NAC were found in all strata (p < .0001) with more substantial increases in HER2 + disease and TNBC compared to HR + /HER2- disease. Multivariable logistic regressions identified the youngest age category (66-69 years) and later stage as significant (p < 0.05) predictors of NAC receipt in most strata, in addition to diagnosis year. CONCLUSION Similar to the overall breast cancer population, NAC use increased among a population of older women. NAC was received by most patients with stage III HER2 + disease or TNBC in more recent years and was more common among younger elderly women and those in stage III.
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Affiliation(s)
- Hanxi Zhang
- College of Pharmacy, The University of Texas at Austin, 2409 University Ave, Austin, TX, 78712, USA
| | - Jamie C Barner
- College of Pharmacy, The University of Texas at Austin, 2409 University Ave, Austin, TX, 78712, USA.
| | - Leticia R Moczygemba
- College of Pharmacy, The University of Texas at Austin, 2409 University Ave, Austin, TX, 78712, USA
| | - Karen L Rascati
- College of Pharmacy, The University of Texas at Austin, 2409 University Ave, Austin, TX, 78712, USA
| | - Chanhyun Park
- College of Pharmacy, The University of Texas at Austin, 2409 University Ave, Austin, TX, 78712, USA
| | - Dhatri Kodali
- Texas Oncology, Deke Slayton Cancer Center, Webster, TX, USA
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van Egdom LSE, de Ligt KM, de Munck L, Koppert LB, Mureau MAM, Rakhorst HA, Siesling S. Predictors of delayed breast reconstruction in the Netherlands: a 5-year follow-up study in stage I-III breast cancer patients. Breast Cancer 2022; 29:324-335. [PMID: 34780034 PMCID: PMC8885490 DOI: 10.1007/s12282-021-01313-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 10/31/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Delayed breast reconstruction (DBR) is a valid option for postmastectomy breast cancer patients who have a desire for breast reconstruction but are not considered suitable for immediate breast reconstruction (IBR). The objective of this study was to investigate the clinical practice and predictors of the use of DBR in the Netherlands. METHODS Stage I-III breast cancer patients diagnosed from January to March 2012 and treated with mastectomy were selected from the Netherlands Cancer Registry. Routinely collected patient, tumor, treatment and hospital characteristics were complemented with data about DBR up to 2018. Multivariable logistic regression analyses were performed to identify factors independently associated with postmastectomy DBR. Factors associated with time to DBR were identified through Cox regression analyses. RESULTS Of all patients who underwent mastectomy (n = 1,415), 10.2% underwent DBR. DBR patients more often received autologous reconstruction compared to IBR patients (37.5% vs 6.2%, p < 0.001). Age below 50 years (age < 35 OR 15.55, age 35-49 OR 4.18) and neoadjuvant and adjuvant chemotherapy (OR 2.59 and OR 2.83, respectively) were significantly associated with DBR. Mean time to DBR was 2.4 years [range 1-6 years]. Time to DBR was significantly associated with age < 35 years (HR 2.22), and a high hospital volume (HR 1.87). DISCUSSION The use of DBR after mastectomy could not be fully explained by age below 50 years, chemotherapy, and hospital volume. Treatment with radiotherapy and adjuvant chemotherapy increased time to DBR. More information about patient preferences is needed to understand the use and timing of reconstruction.
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Affiliation(s)
- L S E van Egdom
- Department of Surgical Oncology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands.
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center, P.O. 2040, 3000 CA, Rotterdam, the Netherlands.
| | - K M de Ligt
- Department of Psychosocial Research, Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - L de Munck
- Department of Research and Development, Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - L B Koppert
- Department of Surgical Oncology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - M A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center, P.O. 2040, 3000 CA, Rotterdam, the Netherlands
| | - H A Rakhorst
- Department of Plastic and Reconstructive Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | - S Siesling
- Department of Research and Development, Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
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