Exploring the association between post-operative complications, disease-recurrence & mortality in primary operable breast cancer—systematic review & meta-analysis
Notice bibliographique
Résumé
Background: Post-operative complications (POCs) affect 36.1% of breast cancer patients. POCs are associated with inferior oncological outcomes in gastro-intestinal, lung, and head and neck cancers. Evidence is less clear in breast cancer. The James Lind Alliance demonstrated the importance of exploring risk factors for disease-recurrence to both patients and clinicians. We reviewed the evidence and performed a meta-analysis to better understand the association between POCs, disease-recurrence and mortality in primary breast cancer. Methods: A PubMed search was conducted on 1st February 2024. Journal titles and abstracts were screened for suitability. Bibliographies of suitable studies were hand-searched for additional eligible studies. Original articles focusing on oncological outcomes after the development of POCs in primary breast cancer were included. Articles analysing risk factors for development of POCs or those assessing in situ or metastatic disease were excluded. Studies were evaluated using the Newcastle-Ottawa Scale. Meta-analysis was performed using a random effects model and presented using Forest plots. Results: Sixteen original studies were included in our review. Two large population studies demonstrate inferior survival in elderly patients who develop major surgical or medical complications, however, neither study accounts for recurrence or cancer-specific survival. Evidence for other comorbidities is lacking. Mastectomy demonstrates increased POC risk and is associated with inferior survival compared to conservation surgery [overall: hazard ratio (HR) 1.32, 95% confidence interval (CI): 1.15–1.51; cancer-specific: HR 1.31, 95% CI: 1.04–1.65]. There is however a paucity of evidence exploring impact of POCs following oncoplastic and/or reconstructive surgery. Meta-analysis demonstrated a significant effect of POCs in increasing the risk of recurrence (HR 1.35, 95% CI: 1.17–1.56, P<0.001), though a high degree of heterogeneity was noted (I2=86%). Variability in ‘wound complication’ definition and associated incidence, as well as the primary outcome reported (locoregional; systemic; any-site recurrence) was noted. Meta-analysis demonstrated a significant impact of POCs on the risk of all-cause mortality (HR 1.27, 95% CI: 1.17–1.39, P<0.001), with no heterogeneity observed (I2=0%). Conclusions: Increased age and mastectomy increase the risk of POC with associated inferior survival. The impact on disease-recurrence remains uncertain. Prospective studies with well-defined criteria are required, alongside studies exploring cellular level changes in primary breast cancer to better understand the underlying mechanism.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,001 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».