抽象的
背景：儘管有大量投資、研究和新的治療方法，但乳腺癌是全球 100 多個國家癌症死亡的主要原因。抑鬱和生活質量、心理狀態和身體形象的動態變化應橫向衡量，並在決策過程中作為手術決策過程中的臨床結果考慮
目的：本研究旨在進行系統評價，以確定乳腺癌術後一年與乳房再造術相比，乳房切除術後抑鬱的風險，並探討生活質量 (QoL)、焦慮/抑鬱狀態的動態變化。 ，以及在 8 年的隨訪期內接受不同類型乳腺癌 (BC) 手術的女性的身體形象 (BI)。
方法：研究第一部分，系統評價和薈萃分析。
根據 PRISMA，使用四個數據庫進行了文獻檢索：Medline (Ovid)、Embase、Cinahl 和 Cochrane 圖書館，時間為 2000 年 1 月至 2019 年 3 月。包括在一年內和手術後測量抑鬱狀態的研究。通過使用事件發生率和 95% CI 的風險比、p 值和基於乳房切除術和 BR 的異質性檢驗結果的擬合模型來分析抑鬱症的結果。使用 CMA 軟件 3.0 版進行統計分析。
第二部分：8年生活質量、心理狀態和BI的動態變化
接受主要 BC 手術的女性被邀請在手術後 8 年內完成世界衛生組織生活質量簡報 (WHOQOL-BREF)、歐洲生活質量五維度問卷 (EQ-5D) 和身體形象量表。應用內核平滑方法來描述不同時間點的 QoL、焦慮/抑鬱和 BI 的動態變化。構建線性混合效應模型來確定這些患者的時間、不同類型的手術和生活質量的決定因素之間的相互作用。
結果：研究第一部分，系統評價和薈萃分析
九項研究符合納入標準。其中 865 例僅接受了乳房切除術，有 22.2% 的抑郁風險（95% CI 12.4 - 36.2）。在接受 BR 的 869 名女性中，抑鬱症的風險為 15.7%（95% CI 8.8 - 26.2）。與 BR 相比，乳房切除術的抑郁風險比為 1.36 (95 % CI 1.11 - 1.65)。延遲重建的病例表現出較低水平的抑鬱症（風險比 0.96, 95% CI 0.57-1.01）。 Beck 抑鬱量表 (BDI) 量表顯示出高靈敏度，而臨界點 >7 的醫院焦慮抑鬱量表甚至可以測量低至中度的抑鬱症狀。
第二部分：8年生活質量、心理狀態和BI的動態變化
共有 1,803 名接受過乳房切除術、改良根治性乳房切除術 (MRM) 和乳房重建術 (BR) 的女性被納入研究。 BR 組在術後 1 至 5 年表現出較高的 WHOQOL 生活質量評分，但有一些波動。 MRM 組的 WHOQOL 項目相對穩定，QoL 評分較低，抑鬱/焦慮較少。 BR 組術後 2 年普遍表現出波動、較低的 BI 評分，但 5 年後表現出更多的焦慮/抑鬱狀態。醫學合併症、焦慮/抑鬱狀態和 BI 是影響 WHOQOL BREF 所有領域和項目的主要因素。
結論：
延遲 BR 更有益於減少抑鬱症狀，BR 將在前 5 年顯著改善他們的生活質量。這些全面的研究結果將被建議在患者參與的乳房手術決策中考慮和討論這些結果。未來的研究需要側重於定性的視角，以開發手術後五年及以後的實際情景，涉及乳腺癌患者、她們的家庭成員和她們的醫療團隊。

Abstract
Background: Breast cancer is the leading cause of cancer death in over 100 countries globally, despite significant investment, research, and new treatments. Depression and dynamic changes of QoL, psychological status, and body image should be measured laterally and considered in the decision-making process as clinical outcomes in the surgical decision-making process
Purpose: The study aims to conduct a systematic review to determine the risk of depression after mastectomy compared with breast reconstruction among women with breast cancer one year after surgery, and to explore the dynamic changes in Quality of Life (QoL), anxiety/depression status, and body image (BI) of women who received different types of breast cancer (BC) surgery within an 8-years follow-up period.
Method: Study part I, systematic review and meta-analysis.
A literature search was conducted using four databases: Medline (Ovid), Embase, Cinahl, and the Cochrane Library for the period January 2000 to March 2019 according to PRISMA. Studies that measured the status of depression within one year and after surgery were included. Outcomes of depression were analyzed by using a pool of event rates and risk ratio of 95% CI, p-value, and a fitting model based on the results of heterogeneity test of mastectomy and BR. The statistical analysis was conducted using CMA Software Version 3.0.
Part II: The dynamic changes in QoL, psychological status, and BI for 8 years
Women with major BC surgeries were invited to complete the World Health Organization Quality of Life–Brief (WHOQOL-BREF), the European quality of life five dimensions questionnaire (EQ-5D), and a body image scale within 8 years of surgery. Kernel smoothing methods were applied to describe dynamic changes in QoL, anxiety/depression, and BI at different time points. Linear mixed-effects models were constructed to identify the interaction between time, different types of surgery, and the determinants of QoL in these patients.
Results: Study part I, systematic review and meta-analysis
Nine studies met the inclusion criteria. 865 of these cases underwent mastectomy only, with a 22.2% risk of depression (95% CI 12.4 - 36.2). In 869 women who underwent BR, the risk of depression was 15.7% (95% CI 8.8 - 26.2). The depression risk ratio for mastectomy compared with BR was 1.36 (95 % CI 1.11 - 1.65). Cases with delayed reconstruction exhibited lower levels of depression (risk ratio 0.96, 95% CI 0.57- 1.01). The Beck Depression Inventory (BDI) scale showed high sensitivity, and the Hospital Anxiety Depression Scale with a cutoff point >7 could measure even low to moderate depressive symptoms.
Part II: The dynamic changes in QoL, psychological status, and BI for 8 years
A total of 1,803 women who had undergone a mastectomy, a modified radical mastectomy (MRM), and breast reconstruction (BR) were included. The BR group exhibited a high QoL score of WHOQOL one to five years after surgery with some fluctuations. The MRM group had comparatively stable, low QoL scores of WHOQOL items and was less depressed/anxious. BR group generally showed fluctuated, lower scores of BI two years after the operation, but they exhibited more anxiety/depression status after five years. Medical comorbidities, the status of anxiety/depression, and BI were the major factors influencing all domains and items of the WHOQOL BREF.
Conclusions:
Delayed BR has more benefits to be fewer depressive symptoms and BR would significantly improve their QoL in the first 5 years. These comprehensive study findings will be recommended that these findings should be considered and discussed in the patient participatory decision-making for breast surgery. Future studies need to focus on a qualitative perspective to develop actual scenarios five years post-surgery and beyond involving women with breast cancer, their family members, and their health care teams.

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