Survival in breast cancer patients with a delayed DIEP flap breast reconstruction after adjustment for socioeconomic status and comorbidity

Adam, H.; Skogh, A.C. Docherty; Nord, Anette; Schultz, Inkeri; Gahm, Jessica; Hall, Per; Frisell, Jan; Halle, Martin; Boniface, Jana de

doi:10.1016/j.breast.2021.07.001

Cited by 3 publications

(2 citation statements)

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“…Women with breast cancer undergoing breast reconstruction are commonly younger and healthier, and have a higher socioeconomic status than their counterparts not receiving reconstruction 23 , 24 . Women who undergo breast reconstruction tend to have better survival than those with comparable disease and treatment characteristics, suggesting a selection bias present at the time of surgical planning 25–27 .…”

Section: Discussionmentioning

confidence: 99%

Major surgical postoperative complications and survival in breast cancer: Swedish population-based register study in 57 152 women

Boniface

Szulkin

Johansson

2022

British Journal of Surgery

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Background Postoperative complications may activate prometastatic systemic pathways through tissue damage, wound healing, infection, and inflammation. Postoperative complications are associated with inferior survival in several types of cancer. The aim was to determine the association between postoperative complications and survival in breast cancer. Methods This population-based cohort included women operated for T1–3 N0–3 M0 invasive breast cancer in Sweden from 2008 to 2017. Only major surgical postoperative complications leading to readmission and/or reoperation within 30 days were considered. Main outcomes were overall survival (OS) and breast cancer-specific survival (BCSS). Prospectively collected nationwide register data were used. Multivariable Cox models were adjusted for clinical and socioeconomic confounders and co-morbidity. Results Among 57 152 women, major surgical postoperative complications were registered for 1854 patients. Median follow-up was 6.22 (0.09–11.70) years. Overall, 9163 patients died, and 3472 died from breast cancer. Major surgical postoperative complications were more common after mastectomy with or without immediate reconstruction (7.3 and 4.3 per cent respectively) than after breast-conserving surgery (2.3 per cent). Unadjusted 5-year OS and BCSS rates were 82.6 (95 per cent c.i. 80.8 to 84.5) and 92.1 (90.8 to 93.5) per cent respectively for women with a major surgical postoperative complication, and 88.8 (88.6 to 89.1) and 95.0 (94.8 to 95.2) per cent for those without a complication (P < 0.001). After adjustment, all-cause and breast cancer mortality rates remained higher after a major surgical postoperative complication (OS: HR 1.32, 95 per cent c.i. 1.15 to 1.51; BCSS: HR 1.31, 1.04 to 1.65). After stratification for type of breast surgery, this association remained significant only for women who had mastectomy without reconstruction (OS: HR 1.41, 1.20 to 1.66; BCSS: HR 1.36, 1.03 to 1.79). Conclusion Major surgical postoperative complications are associated with inferior survival, especially after mastectomy. These results underline the importance of surgical de-escalation.

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Section: Discussionmentioning

confidence: 99%

Major surgical postoperative complications and survival in breast cancer: Swedish population-based register study in 57 152 women

Boniface

Szulkin

Johansson

2022

British Journal of Surgery

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“…The results of subgroup analysis showed that OS was better for those receiving ABR who lived in urban areas. Some studies have shown that patients receiving ABR have higher education compared to mastectomy patients (43), and patients with commercial insurance and higher levels of education were more likely to undergo post-mastectomy reconstruction (44). These social factors can lead to a positive impact in OS, but it is difficult to evaluated this impact.…”

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Survival outcomes of autologous breast reconstruction after mastectomy: A matched case-control study

Ma²,

Zhang³

et al. 2023

Front. Oncol.

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BackgroundDue to the lack of strong evidence-based medical evidence, the relationship between autologous breast reconstruction (ABR) after mastectomy and long-term prognosis is unclear. This study aims to explore if ABR after mastectomy is associated with the prognosis of breast cancer (BC) patients based on the data from the Surveillance, Epidemiology, and End Results (SEER) database.MethodsWe collected data for all cases diagnosed with BC who underwent or did not undergo ABR after mastectomy from 2010-2015 in the SEER database. The primary outcome of our study was overall survival (OS) and cancer specific survival (CSS). The Propensity Score-Matched (PSM) analysis was used to eliminate the effects of non-random statistics, setting the caliper as 0.0001 to balance the baseline variables within the groups. Chi-square test, Kaplan-Meier method, univariate and multivariate cox regression analysis were used to analyze the data and subgroup analysis was performed to find the subgroups of people who might benefit from ABR.ResultOf 27893 eligible patients, 11038 patients were matched. The cohort consisted of 5519 (50%) ABR patients and 5519 (50%) non-ABR patients after PSM. After PSM, on multivariate cox regression analysis, ABR still exerted a significant influence on the OS (hazard ratio (HR), 0.83, P< 0.05). However, no statistical difference was shown on CSS (HR, 0.93, P = 0.31). Kaplan-Meier survival analysis showed ABR group had better OS (P = 0.001), but similar CSS (P = 0.174) between ARB and mastectomy groups. Subgroup analysis showed that after matching, those with 50-59 years old, earlier stages of disease, without a marital partner and living in urban areas had better OS after ABR.ConclusionsABR after mastectomy was associated with better OS, but not affect CSS.

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Health Inequities in the Epidemiology, Diagnosis, Treatment, and Outcomes of Plastic Surgery: A Scoping Review

Moore,

Nees,

Jacobsen

et al. 2023

Plast Surg (Oakv)

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Background: Plastic surgery is routinely sought after for the treatment of breast cancer, cleft lip and palate, and gender-affirming care. Inequities exist in plastic surgery in regard to the epidemiology, diagnosis, treatment, and outcomes experienced by patients. The purpose of our scoping review was to (1) outline current literature addressing health inequities in plastic surgery and (2) draw attention to the gaps in this literature. Methods: This scoping review was developed following guidelines from the Joanna Briggs Institute and PRISMA extension for scoping reviews. An initial search of MEDLINE (via PubMed), Ovid Embase, Cochrane Database of Systematic Reviews, and Scopus databases was performed to locate published articles on health inequities in plastic surgery. Articles had to address at least one of the National Institutes of Health's inequity groups we examined. Results: After reviewing full text, 153 studies were included in our final sample. We found race/ethnicity (94/153) and age (90/153) to be the 2 most commonly evaluated inequities in the scoping review. We discovered that patient populations that were older had public or no insurance and/or were in historically marginalized racial/ethnic groups were often less likely to be offered plastic surgery treatments. Conclusion: This scoping review describes the current literature on health inequities in plastic surgery and highlights gaps in the literature that warrant further research. We found significant findings regarding how vulnerable patient populations are affected by health inequities. Research should be conducted to investigate these inequities more thoroughly and discover the best solutions to bridge the gaps in providing equitable care.

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Survival in breast cancer patients with a delayed DIEP flap breast reconstruction after adjustment for socioeconomic status and comorbidity

Cited by 3 publications

References 50 publications

Major surgical postoperative complications and survival in breast cancer: Swedish population-based register study in 57 152 women

Major surgical postoperative complications and survival in breast cancer: Swedish population-based register study in 57 152 women

Survival outcomes of autologous breast reconstruction after mastectomy: A matched case-control study

Health Inequities in the Epidemiology, Diagnosis, Treatment, and Outcomes of Plastic Surgery: A Scoping Review

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