by L. Moscetti, I. Sperdutia, A. Frassoldati, A. Musolino,
C. Nasso, A. Toss, C. Omarini, M. Dominici, F. Piacentini
The Breast: Published, July 14, 2021
Purpose
Overall survival in breast cancer patients receiving a
delayed deep inferior epigastric perforator (DIEP) flap breast reconstruction
is better than in those without delayed breast reconstruction. This study aimed
at determining the impact of socioeconomic status (SES) and comorbidity on
these observations.
Materials and methods
This matched cohort study included all consecutive women
undergoing a delayed DIEP flap reconstruction at Karolinska University
Hospital, Sweden, between 1999 and 2013. Controls had not received any delayed
breast reconstruction and were relapse-free after a corresponding follow-up
interval. Matching was by year of and age at mastectomy, tumour stage and lymph
node status. Charlson Comorbidity Index (CCI) and socioeconomic data were obtained
from national registers. Associations with breast cancer-specific (BCSS) and
overall survival (OS) were investigated by Kaplan-Meier survival estimates and
Cox proportional hazard regression analysis.
Results
Women in the DIEP group (N = 254) more often continued
education after primary school (88.6% versus 82.6%, P = 0.026), belonged to the
high-income group (76.0% versus 63.1%, P < 0.001), were in a partnership
(57.1% versus 55.7%, P = 0.024) and healthier (median CCI 1.00 (range 0–13)
versus 2.00 (range 0–16), P = 0.021) than the control group (N = 729). After
adjustment for tumour and treatment factors, SES and comorbidity, OS remained
significantly better for the DIEP group than the control group (HR 2.27, 95% CI
1.44–3.55).
Conclusion
Women with a delayed DIEP flap reconstruction are a subgroup
of higher socioeconomic status and better health. Higher survival estimates for
the DIEP group persisted after adjusting for those differences, suggesting the
presence of further unmeasured covariates.
