Delay of Adjuvant Chemotherapy After Elective Mastectomy and Immediate Reconstruction in Breast-conservation Candidates A Matched-pair Analysis

作者：Barry Parul N^*; Riley Elizabeth C; Pan Jianmin; Crew John B; Lee Kiwhoon; Jain Dharamvir; Kruse Barbara; Quillo Amy R; Rai Shesh; Dragun Anthony E

来源：American Journal of Clinical Oncology: Cancer Clinical Trials , 2014, 37(6): 575-579.

DOI：10.1097/COC.0b013e318280d79f

• initiation of chemotherapy
• mastectomy and immediate reconstruction
• breast conservation
• treatment modalities for breast cancer

Objectives: To analyze factors that influence the timing of adjuvant chemotherapy in patients who are candidates for breast-conservation therapy (BCT) but elect mastectomy with immediate reconstruction (M-IR). %26lt;br%26gt;Methods: We identified 35 consecutively treated patients with stage I or II breast cancer between 2004 and 2009 who underwent M-IR and adjuvant chemotherapy from the University of Louisville Cancer Registry. We matched these patients for age and AJCC stage to 35 controls who underwent BCT and adjuvant chemotherapy. We examined the timing and delay of initiation of chemotherapy using univariate logistic regression and McNemar test for matched pairs. %26lt;br%26gt;Results: For the 70 patients evaluated, the median age was 46 years (range, 30 to 65 y), and the distribution for stage I, IIA, and IIB was 22.9%, 65.7%, and 11.4%, respectively. The 2 groups were well balanced in terms of race, rural/urban status, smoking, diabetes, insurance coverage, and histology. For BCT and M-IR, the median time to chemotherapy initiation was 38 days (range, 25 to 103 d) and 55 days (range, 30 to 165 d), respectively. Patients undergoing M-IR were more likely to experience any delay (%26gt; 45 d; 54.3% vs. 22.9%; P %26lt; 0.001) and/or significant delay (%26gt; 90 d; 20.0% vs. 2.9%; P %26lt; 0.001). On univariate logistic regression analysis, surgery type had a major impact on delay of chemotherapy (odds ratio = 8.35; 95% confidence interval, 2.86-24.4; P %26lt; 0.001). %26lt;br%26gt;Conclusions: The use of M-IR in breast-conservation candidates independently predicts for delay in initiation of adjuvant chemotherapy. Further study is needed to qualify the causes and clinical significance of these delays.

• 出版日期2014-12