Research on the Role of Marriage Status Among Women Underwent Breast Reconstruction Following Mastectomy: A Competing Risk Analysis Model Based on the SEER Database, 1998-2015.

Juan Li,Can Zhou,Zejian Yang,Pei Qiu,Siyuan Zhang

doi:10.3389/fsurg.2021.803223

Abstract

BackgroundMarital status is an important foundation of social public relations in modern society, but little is known about the role of marriage status among women who underwent breast reconstruction following mastectomy. This research mainly aimed to investigate the prognostic value of marital status in breast cancer women who underwent breast reconstruction.MethodsThe demographic and clinical data of patients were obtained from the Surveillance, Epidemiology, and End Results (SEER) Program database. The eligible population was assessed on overall survival (OS), breast cancer-specific survival (BCSS), and breast cancer-specific death (BCSD) through propensity score matching (PSM) method, multivariate Cox proportional hazards model analysis, competing risk model analysis, multivariate competing risk regression model analysis, and subgroup analysis.ResultsOf the 54,683 women included in the current study, a total of 38,110 participants were married patients (married group), and 16,573 participants were unmarried patients (unmarried group). Patients in the married group tended to have better OS (hazard ratio [HR] = 1.397, 95% CI: 1.319–1.479, p < 0.001), BCSS (HR = 1.332, 95% CI: 1.244–1.426, p < 0.001), cumulative BCSD incidence (Gray's test, p < 0.001), and other causes-specific death (OCSD) incidence (Gray's test, p < 0.001) than those in the unmarried group. In subgroup analysis, subjects with HR+/HER2– subtype breast cancer in the married group showed improved OS (1.589, 95% CI: 1.363–1.854, p < 0.001) and BCSS (HR = 1.512, 95% CI: 1.255–1.82, p < 0.001) than those in the unmarried group.ConclusionsOur study demonstrated that the inexistence of marriage was associated with poorer OS and BCSS, especially for HR+/HER2– breast cancer women who underwent breast reconstruction.

Highlights

Since Halsted’s radical mastectomy was firstly described in 1882, the awareness and innovations in the reconstructive technique of breast reconstruction have evolved slowly, due to the improving understanding of the biology of breast cancer, paradigmatic evolution in oncologic [1]
The eligible population was assessed on overall survival (OS), breast cancer-specific survival (BCSS), and breast cancer-specific death (BCSD) through propensity score matching (PSM) method, multivariate Cox proportional hazards model analysis, competing risk model analysis, multivariate competing risk regression model analysis, and subgroup analysis
Patients in the married group tended to have better OS, BCSS (HR = 1.332, 95% CI: 1.244–1.426, p < 0.001), cumulative BCSD incidence (Gray’s test, p < 0.001), and other causes-specific death (OCSD) incidence (Gray’s test, p < 0.001) than those in the unmarried group

Summary

Introduction

Since Halsted’s radical mastectomy was firstly described in 1882, the awareness and innovations in the reconstructive technique of breast reconstruction have evolved slowly, due to the improving understanding of the biology of breast cancer, paradigmatic evolution in oncologic [1] Both immediate and delayed breast reconstruction have experienced a gradual rise over the past few decades. Breast reconstruction means the maintenance of life quality through restoring form, self-perception, and psychosocial and aesthetic benefits, without affecting the long-term prognosis or detection of locoregional recurrence of cancer through restoring the mound of the breast [4] For these reasons, it would be essential to investigate and identify the factors predicting the long-term tumor survival and prognosis of breast reconstruction. This research mainly aimed to investigate the prognostic value of marital status in breast cancer women who underwent breast reconstruction

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