Background: As survival rates among breast cancer (BC) patients continue to rise, Emotional Functioning (EF)—has become increasingly clinically relevant; however, researchers have yet to fully characterize its long-term, dynamic trajectories following surgery. This systematic review and meta-analysis aimed to (1) characterize the longitudinal trajectories of EF after BC surgery and (2) examine the moderating effects of surgical modality and age.Methods: We conducted this systematic review and meta-analysis in accordance with PRISMA 2020 guidelines. We synthesized data from studies published between 2000 and 2024 that assessed EF using the EORTC QLQ-C30 at multiple post-surgical time points. Using multilevel random-effects meta-analytic models, we examined EF trajectories across 116 effect sizes derived from 40 studies, and evaluated time, surgical modality (breast-conserving surgery (BCS), mastectomy (MA), mastectomy with immediate reconstruction (Mx + IR) and age group as moderators.Results: The overall pooled estimate for EF was 73.44 (95% CI: 70.29–76.58,p< 0.001). Time since surgery significantly influenced EF: scores were lowest during the initial 6 months (66.82, 95% CI: 59.75–73.89), peaked at 7–15 months (77.86, 95% CI: 74.51–81.22) and 31–54 months (77.52, 95% CI: 70.44–84.59), and showed lower values at 16–30 months (72.58, 95% CI: 61.45–83.72) and 55–72 months (69.81, 95% CI: 64.08–75.54). Surgical modality significantly shaped these trajectories (p= 0.013). The overall pooled estimate for EF was 73.44 (95% CI: 70.29–76.58,p< 0.001). Time since surgery significantly influenced EF: scores were lowest during the initial 6 months (66.82, 95% CI: 59.75–73.89), peaked at 7–15 months (77.86, 95% CI: 74.51–81.22) and 31–54 months (77.52, 95% CI: 70.44–84.59), and showed lower values at 16–30 months (72.58, 95% CI: 61.45–83.72) and 55–72 months (69.81, 95% CI: 64.08–75.54). Surgical modality significantly shaped these trajectories (p= 0.013). The BCS group showed a significant inverted-U trajectory in EF scores, with a positive linear slope (β = 1.22, SE = 0.50,p= 0.046) and a small negative quadratic term (β = −0.02, SE = 0.01,p= 0.046), indicating initial improvement followed by decline. A similar pattern was observed for MA, where the linear term (β = 1.19, SE = 0.51,p= 0.054) and quadratic curvature (β = −0.02, SE = 0.01,p= 0.054) suggested an early rise with subsequent decline. In contrast, Mx + IR displayed a high intercept (β = 71.46, SE = 4.46,p< 0.001) but no significant trajectory over time (p= 0.582), indicating stability. The 45–60 year group demonstrated a significant inverted-U trajectory in EF scores, with a positive linear coefficient (β = 0.87, SE = 0.38,p= 0.067) and a negative quadratic coefficient (β = −0.01, SE = 0.01,p= 0.067), suggesting an early rise in emotional functioning followed by a subsequent decline. Participants <45 years also showed a significant inverted-U pattern, starting from a moderately high baseline (β = 67.56, SE = 4.26,p< 0.001) with a positive linear slope (β = 0.82, SE = 0.34,p= 0.051) and a negative quadratic curvature (β = −0.01, SE = 0.01,p= 0.051). In contrast, the >60 year group reported the highest baseline scores (β = 75.60, SE = 5.18,p< 0.001) with no significant trajectory, indicating overall stability. These findings confirm that EF follows a significant inverted-U trajectory (p< 0.001) and is influenced by time, surgical modality, and age.
背景：随着乳腺癌患者生存率的持续提升，情绪功能作为一项临床指标的重要性日益凸显，然而其术后长期动态轨迹尚未得到充分阐释。本系统综述与荟萃分析旨在：（1）描述乳腺癌术后情绪功能的纵向轨迹特征；（2）探讨手术方式与年龄的调节效应。 方法：本研究严格遵循PRISMA 2020指南开展系统综述与荟萃分析。我们整合了2000年至2024年间发表的、使用EORTC QLQ-C30量表在术后多个时间点评估情绪功能的研究数据。通过多层随机效应荟萃分析模型，基于40项研究产生的116个效应值分析情绪功能轨迹，并评估时间、手术方式（保乳手术、乳房切除术、乳房切除联合即刻重建术）及年龄分组的调节作用。 结果：情绪功能总体合并估计值为73.44（95% CI：70.29–76.58，p<0.001）。术后时间对情绪功能具有显著影响：术后6个月内评分最低（66.82，95% CI：59.75–73.89），在7-15个月（77.86，95% CI：74.51–81.22）和31-54个月（77.52，95% CI：70.44–84.59）达到峰值，而在16-30个月（72.58，95% CI：61.45–83.72）及55-72个月（69.81，95% CI：64.08–75.54）呈现较低值。手术方式显著影响轨迹形态（p=0.013）：保乳手术组呈现显著倒U型轨迹，线性斜率为正（β=1.22，SE=0.50，p=0.046），二次项系数为负（β=-0.02，SE=0.01，p=0.046），表明情绪功能先升后降；乳房切除术组呈现相似模式，线性项（β=1.19，SE=0.51，p=0.054）与二次曲率（β=-0.02，SE=0.01，p=0.054）提示早期上升后下降趋势；而乳房切除联合即刻重建术组虽具较高截距（β=71.46，SE=4.46，p<0.001），但随时间推移无显著轨迹变化（p=0.582），呈现稳定状态。 年龄调节分析显示：45-60岁组呈现显著倒U型轨迹，线性系数为正（β=0.87，SE=0.38，p=0.067），二次系数为负（β=-0.01，SE=0.01，p=0.067），提示情绪功能早期改善后回落；<45岁组同样呈现显著倒U型模式，从中高基线水平起步（β=67.56，SE=4.26，p<0.001），具有正线性斜率（β=0.82，SE=0.34，p=0.051）与负二次曲率（β=-0.01，SE=0.01，p=0.051）；而>60岁组基线评分最高（β=75.60，SE=5.18，p<0.001）且无显著轨迹变化，表明整体保持稳定。 结论：本研究证实情绪功能遵循显著倒U型轨迹演变（p<0.001），并受到术后时间、手术方式及年龄的共同影响。
肿瘤(癌症)患者之家