PO.PS01.04 · 人群科学
评估中伊利诺伊乳腺癌项目中乳腺癌手术后乳房重建的差异
Assessment of disparities in breast reconstruction following breast cancer surgery at a Central Illinois Breast Cancer Program
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
引言：尽管重建率有所提高且有立法努力改善可及性，乳房切除术后乳房重建的差异仍然存在。既往研究显示，种族和民族少数群体、社会经济地位较低者、参保医疗保险/医疗补助者、年龄较大者以及居住在农村地区的个体重建率较低。
方法：我们对99名患者（>18岁）进行了一项回顾性队列研究，这些患者于2020年1月至2022年12月间在我院接受了全乳/单纯、保留皮肤、保留乳头或改良根治性乳房切除术治疗乳腺癌。接受部分乳房切除术/肿块切除术的患者被排除。临床、人口统计学、社会经济和手术数据从电子病历中提取并在REDCap中管理。农村与城市居住地采用RUCC代码确定（1-3为城市；4-9为非城市）。主要结局为接受乳房切除术后乳房重建。
结果：队列中大多数患者为白人（87%），种族和民族少数群体占比较小。种族与接受乳房重建无显著关联。接受重建的患者显著比未接受者更年轻（50.4±11.7 vs 61.6±12.3岁，p<0.0001）。地理居住地（城市 vs 非城市）、吸烟状况和合并症（包括2型糖尿病、充血性心力衰竭和COPD）与重建无关。癌症分期以及接受辅助化疗或放疗也未显著影响重建率。接受对侧预防性乳房切除术的患者显著更可能接受重建（p=0.00005）；其中只有3名患者携带BRCA突变，其余则出于个人选择而接受该手术。
结论：在我们的队列中，较年轻的年龄和接受对侧预防性乳房切除术是乳房切除术后重建最强的预测因素。其他人口统计学和临床因素，包括种族、地理居住地和辅助治疗，均不影响重建。标准化患者教育和早期转诊至整形外科可能有助于减少差异并支持更公平的护理。
查看英文原文 English abstract
Introduction: Despite increases in reconstruction rates and legislative efforts to improve access, disparities in post-mastectomy breast reconstruction persist. Prior studies have shown lower reconstruction rates among racial and ethnic minorities, patients with lower socioeconomic status, those insured with Medicare/Medicaid, older patients, and individuals living in rural areas.
Methods: We performed a retrospective cohort study of 99 patients (>18 years) who underwent total/simple, skin-sparing, nipple-sparing, or modified radical mastectomy for breast cancer between January 2020 and December 2022 at our institution. Patients who underwent partial mastectomy/lumpectomy were excluded. Clinical, demographic, socioeconomic, and operative data were extracted from the electronic medical record and managed in REDCap. Rural vs. urban residence was determined using RUCC codes (1-3 urban; 4-9 non-urban).The primary outcome was receipt of post-mastectomy breast reconstruction.
Results: The majority of patients in the cohort were Caucasian (87%), with racial and ethnic minority groups representing a smaller proportion. Race was not significantly associated with receipt of breast reconstruction. Patients who underwent reconstruction were significantly younger than those who did not (50.4 ± 11.7 vs. 61.6 ± 12.3 years, p < 0.0001). Geographic residence(urban vs. non-urban), smoking status, and comorbidities, including type 2 diabetes, congestive heart failure, and COPD were not associated with reconstruction. Cancer stage and receipt of adjuvant chemotherapy or radiation therapy also did not significantly influence reconstruction rates. Patients who underwent contralateral prophylactic mastectomy were significantly more likely to receive reconstruction (p = 0.00005); of these, only 3 patients had a BRCA mutation, while the remainder opted for the procedure by personal choice.
Conclusion: In our cohort, younger age and undergoing contralateral prophylactic mastectomy were the strongest predictors of post-mastectomy reconstruction. Other demographic and clinical factors, including race, geographic residence, and adjuvant treatment, did not affect reconstruction. Standardizing patient education and early referral to plastic surgery may help reduce variation and support more equitable care.
利益披露 Disclosure
H. A. El Amri, None..
K. Robinson, None..
S. Arikati, None..
K. Delfino, None.