乳房重建（BR）可以改善乳腺癌切除术后妇女的健康相关生活质量（HRQOL），然而对于改善HRQOL的因素仍不清楚。本研究旨在探讨乳房切除术对高危乳腺癌患者HRQOL的整体影响，并在时间上观察患者对HRQOL的感知；检测立即进行乳房重建（immediate BR）、延迟进行乳房重建（delayed BR）和未进行乳房重建（no BR）的患者的平均HRQOL评分差异；评估与HRQOL评分相关的患者特征的影响；以及在临床环境中长期收集患者报告的结果测量的可行性。采用前瞻性纵向研究设计，对100名高危乳腺癌患者进行了乳房切除术（包括或不包括乳房重建）并可能需要术后乳腺放疗。选择了四个经验证的患者报告问卷，包括21个与HRQOL相关的结果指标，在乳房切除术前和术后4年内进行了评估。从患者病历中提取了人口统计学、临床和手术数据。结果显示，未来健康和手臂症状的感知持续显著下降，治疗副作用、乳房症状和疲劳持续显著改善，在社交功能和经济困难方面也比基线有显著改善，这种改善在48个月内。不同乳房重建选择的患者之间的HRQOL评分平均值没有显著差异。高危乳腺癌患者在选择乳房重建时具有类似的HRQOL评分轨迹。知情选择可能是长期保持大多数HRQOL指标在乳腺切除术前水平的独立因素。版权所有 © 2023. Elsevier Ltd. 发表。

Breast reconstruction (BR) improves women's health-related quality of life (HRQOL) following mastectomy for breast cancer, yet factors contributing to improved HRQOL remain unclear. This study aimed to explore the overall impact of mastectomy with or without BR on participants' perceptions of HRQOL over time in a cohort of women with high-risk breast cancer; to examine differences in mean HRQOL scores between immediate BR, delayed BR and no BR groups; to assess the influence of patient characteristics potentially associated with HRQOL scores; and to determine the feasibility of long-term collection of patient-reported outcome measures in clinical settings.A prospective, longitudinal study of 100 women with high-risk breast cancer who underwent mastectomy with or without breast reconstruction and were likely to require post-mastectomy radiotherapy. Four validated patient-reported questionnaires, comprising 21 outcome measures relating to HRQOL, administered at baseline and up to 4 years post-mastectomy. Demographic, clinical and surgical data extracted from patient medical records.Consistently significant declines in perceptions of future health and arm symptoms, consistently significant improvements in treatment side effects, breast symptoms and fatigue, as well as significant improvements, compared to baseline, in social functioning and financial difficulties at 48 months. No significant differences in mean HRQOL scores between women given a choice of reconstructive options.Similar trajectories of HRQOL scores were found in women with high-risk breast cancer who were offered a choice of BR. Informed choice may be an independent contributing factor in long-term maintenance of most HRQOL indicators at their pre-mastectomy levels.Copyright © 2023. Published by Elsevier Ltd.