Background: This study compared the change in pre- and postoperative health-related quality of life (HRQoL) among breast cancer patients undergoing breast-conserving surgery (BCS), total mastectomy no reconstruction (TMNR), and total mastectomy immediate breast reconstruction (MIBR). Patient factors associated with postoperative anxiety and depression were also identified.Methods: This prospective cohort study enrolled breast cancer patients between September 2017 and August 2020. HRQoL changes from preoperative to six months postoperative were compared using patient-reported outcome tools assessing anxiety, depression, pain, perceived health, breast satisfaction, psychosocial, physical, and sexual well-being and analyzed with ANOVA and linear regression.Results: A total of 471 patients completed preoperative and postoperative surveys (BCS: 313, TMNR: 60, MIBR: 98). Postoperative anxiety decreased across all modalities, with MIBR showing the greatest reduction (p= 0.03), though still exhibiting the highest postoperative anxiety (p= 0.05). Depression and perceived health scores showed no significant difference in change across modalities (p= 0.15,p= 0.48). MIBR patients showed the greatest increase in pain (p= 0.05) and the highest postoperative pain scores (p= 0.04). All three modalities showed a clinically significant decline in physical and sexual well-being. TMNR and MIBR had additional reductions in breast satisfaction, with TMNR also showing a decline in psychosocial well-being. Absolute postoperative scores for breast satisfaction, psychosocial, physical, and sexual well-being remained highest in BCS compared to TMNR and MIBR (p< 0.01, for each domain). In multivariable regression analysis, postoperative depression and anxiety scores did not differ between surgical modalities, but younger age was significantly associated with higher postoperative depression, pain and anxiety (p< 0.01), and adjuvant chemotherapy with higher postoperative depression (p< 0.01).Conclusions: BCS may have better overall HRQoL outcomes, specifically in breast satisfaction, psychosocial, physical, and sexual well-being, compared to TMNR and MIBR. Additionally, younger age, rather than surgical modality, was found to be associated with higher postoperative depression, pain, and anxiety scores.
背景：本研究比较了接受保乳手术（BCS）、全乳切除无重建（TMNR）及全乳切除即刻乳房重建（MIBR）的乳腺癌患者术前与术后健康相关生活质量（HRQoL）的变化，并识别了与术后焦虑和抑郁相关的患者因素。 方法：这项前瞻性队列研究于2017年9月至2020年8月期间纳入乳腺癌患者。通过患者报告结局工具评估焦虑、抑郁、疼痛、感知健康、乳房满意度、心理社会健康、身体健康及性健康，比较术前至术后六个月的HRQoL变化，并采用方差分析和线性回归进行统计分析。 结果：共471例患者完成术前及术后调查（BCS：313例，TMNR：60例，MIBR：98例）。所有手术方式的术后焦虑均有所下降，其中MIBR组下降幅度最大（p=0.03），但其术后焦虑水平仍最高（p=0.05）。抑郁和感知健康评分的变化在各组间无显著差异（p=0.15，p=0.48）。MIBR组疼痛增加最显著（p=0.05）且术后疼痛评分最高（p=0.04）。三组患者的身体健康和性健康均出现具有临床意义的下降。TMNR和MIBR组乳房满意度进一步降低，TMNR组还表现出心理社会健康下降。与TMNR和MIBR相比，BCS组在乳房满意度、心理社会健康、身体健康及性健康领域的术后绝对评分均保持最高（各领域p<0.01）。多变量回归分析显示，术后抑郁和焦虑评分在不同手术方式间无差异，但年轻年龄与更高的术后抑郁、疼痛和焦虑显著相关（p<0.01），辅助化疗与更高的术后抑郁相关（p<0.01）。 结论：与TMNR和MIBR相比，BCS可能具有更好的整体HRQoL结局，尤其在乳房满意度、心理社会健康、身体健康及性健康方面。此外，研究发现年轻年龄（而非手术方式）与更高的术后抑郁、疼痛和焦虑评分相关。
肿瘤(癌症)患者之家