Factors associated with surgical options for breast carcinoma
Factors associated with surgical options for breast carcinoma
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DOI：
10.1002/cncr.21728
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发表时间：
2006-04-01
期刊：
影响因子：
6.2
通讯作者：
McMasters, KM
中科院分区：
文献类型：
--
作者：
Chagpar, AB;Studts, JL;McMasters, KM
背景保乳手术（BCS）和乳房切除术对乳腺癌患者的生存结局相同，但治疗决定受许多因素影响。本研究评估了患者和医生因素对手术决策的影响。对浸润性乳腺癌患者的前瞻性多中心研究进行统计分析。患者、医生和地理因素都被考虑在内。在4086例患者中，2762例（67.6%）行BCS，1324例（32.4%）行乳房切除术。乳腺切除术组中位肿瘤大小为1.9 cm（0.1-11.0 cm），BCS组中位肿瘤大小为1.5 cm（0.1-9.0 cm）（P <0.00001）。接受BCS的患者的中位年龄为59岁（范围，27 - 100岁），而接受乳房切除术的患者年龄较大（中位年龄为63岁，范围，27 - 96岁[P <0.000011]）。从事学术实践的医生比不从事学术实践的医生进行了更多的乳房肿瘤切除术（70.9% vs. 65.7%; P = 0.001）。更多的保乳手术是由具有较高比例乳房实践的外科医生进行的（P = 0.012）。地理位置被发现是显着的，与东北部的乳房保护率最高（70.8%）和东南部最低（63.2%; P = 0.002）。在多变量分析中，患者年龄（比值比[OR]：1.455; 95%置信区间[95%CI]，1.247 - 1.699 [P <0.0011），肿瘤大小（P <0.001），肿瘤可触及性（OR：0.613; 95%CI，0.524-0.716 [P <0.001]），组织学亚型（P = 0.018）、肿瘤位于乳腺（P <0.001）、医生学术背景（OR：1.193; 95% CI：1.021-1.393 [P = 0.0261]）和地理位置。位置（P = 0.045）有显著性差异。治疗决定与患者的临床病理特征、外科医生的学术联系和地理位置有关。未来的研究将阐明可能影响患者决策的沟通和心理社会因素。
BACKGROUND. Breast conservation Surgery (BCS) and mastectomy have equivalent survival outcomes for women with breast carcinoma, but treatment decisions are affected by many factors. The current study evaluated the impact of patient and physician factors on surgical decision-making.METHODS. Statistical analyses were performed on a prospective multicenter study of patients with invasive breast carcinoma. Patient, physician, and geographic factors were considered.RESULTS. Of 4086 patients, BCS was performed in 2762 (67.6%) and mastectomy was performed in 1324 (32.4%). The median tumor size was 1.5 cm (range, < 0.1-9.0 cm) in patients undergoing BCS and 1.9 cm (range, 0.1-11.0 cm) in patients undergoing mastectomy (P < 0.00001). The inedian age of patients undergoing BCS was 59 years (range, 27-100 yrs), whereas patients who underwent mastectomy were older (median age of 63 yrs, range, 27-96 yrs [P < 0.000011). Physicians in academic practices performed more lumpectomies than those who were not in an academic practice (70.9% vs. 65.7%; P = 0.001). More breast conservation procedures were performed by surgeons with a higher percentage of breast practice (P = 0.012). Geographic location was found to be significant, with the Northeast having the highest rate of breast conservation (70.8%) and the Southeast having the lowest (63.2%; P = 0.002). On multivariate analysis, patient age (odds ratio [OR]: 1.455; 95% confidence interval [95% CI], 1.247-1.699 [P < 0.0011), tumor size (P < 0.001), tumor palpability (OR: 0.613; 95% CI, 0.524-0.716 [P < 0.001]), histologic subtype (P = 0.018), tumor location in the breast (P < 0.001), physician academic affiliation (OR: 1.193; 95% CI: 1.021-1.393 [P = 0.0261), and geographic. location (P = 0.045) were found to be significant.CONCLUSIONS. Treatment decisions were found to be related to patient clinico-pathologic features, surgeon academic affiliation, and geographic location. Future Studies will elucidate the communication and psychosocial factors that may influence patient decision-making.