Patient and Surgeon Characteristics Associated with Increased Use of Contralateral Prophylactic Mastectomy in Patients with Breast Cancer
Patient and Surgeon Characteristics Associated with Increased Use of Contralateral Prophylactic Mastectomy in Patients with Breast Cancer
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DOI：
10.1245/s10434-009-0641-z
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发表时间：
2009-10-01
影响因子：
3.7
通讯作者：
Tuttle, Todd M.
中科院分区：
文献类型：
--
作者：
Arrington, Amanda K.;Jarosek, Stephanie L.;Tuttle, Todd M.
单侧乳腺癌患者患对侧乳腺癌的风险增加。最近一项基于人群的研究表明，近年来，美国单侧乳腺癌患者接受对侧预防性乳房切除术（CPM）的比例增加了150%。本研究评估了在大都市医院系统中接受乳腺癌手术的患者，以确定与CPM相关的因素。我们回顾了2006年和2007年在一个单一的医疗保健系统中接受乳腺癌手术治疗的所有患者的记录，该系统包括六家不同的医院。排除标准包括术前诊断双侧疾病、IV期疾病和既往乳腺癌病史。我们记录了患者、治疗、肿瘤和外科医生的特征。在571例符合条件的患者中，276例（48.3%）接受了保乳手术（BCS），130例（22.8%）接受了单侧乳房切除术，165例（28.9%）接受了乳房切除术和CPM。在乳房切除术患者中，55.9%接受CPM。年轻（< 40 vs. >55岁）、大肿瘤（> 5与< 2 cm）、阳性家族史、小叶组织学、多中心疾病和外科医生性别（女性）是CPM发生率增加的独立预测因素。体重指数、肿瘤分级、雌激素受体状态和术前乳腺磁共振成像与CPM发生率增加无关。需要前瞻性研究来检查影响患者决策的因素，以开发可能在此过程中帮助患者的资源。
Patients with unilateral breast cancer have an increased risk of developing contralateral breast cancer. A recent population-based study demonstrated that the proportion of patients with unilateral breast cancer in the United States who underwent contralateral prophylactic mastectomy (CPM) has increased by 150% in recent years. The current study evaluated patients who underwent breast cancer surgery in a metropolitan-based hospital system to determine factors associated with CPM.We reviewed the records of all patients who underwent surgical treatment for breast cancer in 2006 and 2007 in a single health care system, which included six different hospitals. Exclusion criteria included preoperative diagnosis of bilateral disease, stage IV disease, and a history of previous breast cancer. We recorded patient, treatment, tumor, and surgeon characteristics. Multivariate logistic regression models were used to predict CPM use.Of 571 eligible patients, 276 (48.3%) underwent breast-conserving surgery (BCS), 130 (22.8%) underwent unilateral mastectomy, and 165 (28.9%) underwent mastectomy and a CPM. Among mastectomy patients, 55.9% underwent CPM. Young age (< 40 vs. > 55 years), large tumor size (> 5 vs. < 2 cm), positive family history, lobular histology, multicentric disease, and surgeon gender (female) were independent predictors of increased CPM rates. Body mass index, tumor grade, estrogen receptor status, and preoperative breast magnetic resonance imaging were not associated with increased CPM rates.Our study is the first to evaluate specific surgeon characteristics associated with CPM use. Prospective studies are needed to examine factors affecting patient decision-making to develop resources that may assist patients in this process.