Reoperation rates after breast conserving surgery for breast cancer among women in England: retrospective study of hospital episode statistics.
Reoperation rates after breast conserving surgery for breast cancer among women in England: retrospective study of hospital episode statistics.
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DOI：
10.1136/bmj.e4505
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发表时间：
2012-07-12
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影响因子：
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通讯作者：
van der Meulen JH
中科院分区：
文献类型：
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作者：
Jeevan R;Cromwell DA;Trivella M;Lawrence G;Kearins O;Pereira J;Sheppard C;Caddy CM;van der Meulen JH
目的探讨保乳术后再手术率是否与患者特征相关，并探讨英国NHS各信托机构的再手术率是否存在差异。设计队列研究使用来自医院事件统计的患者水平数据。设置英国NHS信托。研究对象为2005年4月1日至2008年3月31日期间行保乳手术的成年女性。主要结果测量原发性保乳手术后3个月内的再手术率，根据肿瘤类型、年龄、合并症和社会经济条件进行logistic回归校正。肿瘤的分组是根据原发保乳手术时是否有原位癌成分。结果156家NHS信托机构在3年内对55 297例妇女进行了保乳手术。11032例（20.0%，95%可信区间19.6% ~ 20.3%）患者至少再手术一次。10 212例（18.5%,18.2% ~ 18.8%）仅再手术一次；其中5943例（10.7%，10.5%至11.0%）接受了另一次保乳手术，4269例（7.7%，7.5%至7.9%）接受了乳房切除术。在45793例患有孤立性侵袭性疾病的女性中，8229例（18.0%）至少进行了一次再手术。相比之下，9504例原位癌患者中2803例（29.5%）至少再手术一次（校正优势比为1.9,95%可信区间为1.8 ~ 2.0）。NHS信托机构调整后的再手术率存在显著差异（第10百分位数和第90百分位数分别为12.2%和30.2%）。结论：在英国，五分之一接受保乳手术的妇女再次手术。当肿瘤有原位癌成分编码时，再次手术的可能性几乎是其两倍。在决定乳腺癌的手术治疗方式时，应告知妇女再手术的风险。
Objectives To examine whether rate of reoperation after breast conserving surgery is associated with patients’ characteristics and investigate whether reoperation rates vary among English NHS trusts. Design Cohort study using patient level data from hospital episode statistics. Setting English NHS trusts. Participants Adult women who had breast conserving surgery between 1 April 2005 and 31 March 2008. Main outcome measure Reoperation rates after primary breast conserving surgery within 3 months, adjusted using logistic regression for tumour type, age, comorbidity, and socioeconomic deprivation. Tumours were grouped by whether a carcinoma in situ component was coded at the time of the primary breast conserving surgery. Results 55 297 women had primary breast conserving surgery in 156 NHS trusts during the three year period. 11 032 (20.0%, 95% confidence interval 19.6% to 20.3%) women had at least one reoperation. 10 212 (18.5%, 18.2% to 18.8%) had one reoperation only; of these, 5943 (10.7%, 10.5% to 11.0%) had another breast conserving procedure and 4269 (7.7%, 7.5% to 7.9%) had a mastectomy. Of the 45 793 women with isolated invasive disease, 8229 (18.0%) had at least one reoperation. In comparison, 2803 (29.5%) of the 9504 women with carcinoma in situ had at least one reoperation (adjusted odds ratio 1.9, 95% confidence interval 1.8 to 2.0). Substantial differences were found in the adjusted reoperation rates among the NHS trusts (10th and 90th centiles 12.2% and 30.2%). Conclusion: One in five women who had breast conserving surgery in England had a reoperation. Reoperation was nearly twice as likely when the tumour had a carcinoma in situ component coded. Women should be informed of this reoperation risk when deciding on the type of surgical treatment of their breast cancer.