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Association of postoperative infection and oncological outcome after breast cancer surgery
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.ORCID iD: 0000-0002-5648-5882
2021 (English)In: BJS Open, E-ISSN 2474-9842, Vol. 5, no 4, article id zrab052Article in journal (Refereed) Published
Abstract [en]

Background: Surgical-site infection (SSI) is a well known complication after breast cancer surgery and has been reported to be associated with cancer recurrence. The aim of this study was to investigate the association between SSI and breast cancer recurrence, adjusting for several known confounders. The secondary aim was to assess a possible association between any postoperative infection and breast cancer recurrence.

Method: This retrospective cohort study included all patients who underwent breast cancer surgery from January 2009 to December 2010 in the Uppsala region of Sweden. Data collected included patient, treatment and tumour characteristics, infection rates and outcome. Association between postoperative infection and oncological outcome was examined using Kaplan-Meier curves and Cox regression analysis.

Results: Some 492 patients (439 with invasive breast cancer) with a median follow-up of 8.4 years were included. Mean(s.d.) age was 62(13) years. Sixty-two (14.1 per cent) of those with invasive breast cancer had an SSI and 43 (9.8 per cent) had another postoperative infection. Some 26 patients had local recurrence; 55 had systemic recurrence. Systemic recurrence was significantly increased after SSI with simple analysis (log rank test, P = 0.035) but this was not observed on adjusted analysis. However, tumour size and lymph node status remained significant predictors for breast cancer recurrence on multiple regression. Other postoperative infections were not associated with recurrence.

Conclusion: Neither SSI nor other postoperative infections were associated with worse oncological outcome in this study. Rather, other factors that relate to both SSI and recurrence may be responsible for the association seen in previous studies.

Place, publisher, year, edition, pages
Oxford University Press (OUP) Oxford University Press, 2021. Vol. 5, no 4, article id zrab052
National Category
Surgery
Identifiers
URN: urn:nbn:se:uu:diva-468367DOI: 10.1093/bjsopen/zrab052ISI: 000754552400004PubMedID: 34240113OAI: oai:DiVA.org:uu-468367DiVA, id: diva2:1641469
Funder
Göran Gustafsson Foundation for promotion of scientific research at Uppala University and Royal Institute of TechnologyAvailable from: 2022-03-02 Created: 2022-03-02 Last updated: 2024-12-09Bibliographically approved
In thesis
1. Complications after Breast Cancer Surgery and Oncological Outcomes
Open this publication in new window or tab >>Complications after Breast Cancer Surgery and Oncological Outcomes
2025 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Breast cancer is the most common cancer worldwide for females. A frequent complication following breast cancer surgery is surgical site infection (SSI). Complications can result in diminished quality of life, increased morbidity, elevated healthcare costs, delayed initiation of adjuvant therapy, loss of reconstruction, and potentially adverse oncological outcomes. In Paper I, the primary objective was to investigate the purported association between SSI and breast cancer recurrence. In addition, the study aimed to explore a potential link between any postoperative infection and breast cancer recurrence. This population-based, retrospective cohort study found that neither SSI nor other postoperative infections were associated with worse oncologic outcomes. Paper II investigated risk factors for SSI following breast cancer surgery, as well as risk factors for other wound complications. This research was conducted through a prospectively registered cohort study. Multivariable analysis identified BMI 25-30 and BMI >30 as the only significant risk factors for SSI. Additionally, significant risk factors for any wound complication included mastectomy with or without reconstruction, as well as BMI 25-30 and BMI >30. In Paper III, the primary aim was to evaluate whether SSI increases the risk of systemic breast cancer recurrence. Secondary objectives included assessing the impact of SSI on the risk of locoregional recurrence (LRR), breast cancer-specific survival (BCSS), and overall survival (OS). This analysis utilized high-quality data from national population-based registers, checking for confounding variables such as patient and tumour characteristics. In conclusion, SSI following breast cancer surgery does not significantly increase the risk of systemic recurrence, LRR, overall death, or breast cancer-specific death. Paper IV evaluated the risk of systemic breast cancer recurrence following major systemic postoperative infection or other major event. It also assessed the impact of these exposures on LRR, OS, and BCSS. Utilizing the same cohort as in Paper III, the findings indicated that postoperative major systemic infection was associated with an increased risk of systemic recurrence, overall death and breast cancer-specific death, but not with LRR.

In conclusion, this thesis does not support the hypothesis that SSI is associated with poorer oncological outcomes. However, it demonstrates an association between major systemic infections and worse oncological outcomes.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2025. p. 99
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 2113
Keywords
Breast cancer surgery, postoperative complications, surgical site infection, systemic infection, postoperative major event, risk factors, recurrence, survival, population-based
National Category
Surgery
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-544007 (URN)978-91-513-2336-7 (ISBN)
Public defence
2025-02-07, H:son Holmdahlsalen, Akademiska sjukhuset, ing 100, våning 1, Dag Hammarskjölds Väg 8, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2025-01-17 Created: 2024-12-09 Last updated: 2025-01-17

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Adwall, LindaPantiora, EiriniHultin, HellaNorlén, Olov

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