Clinicopathologic factors and patient perceptions associated with surgical breast-conserving treatment
Clinicopathologic factors and patient perceptions associated with surgical breast-conserving treatment
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DOI：
10.1007/bf02305797
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发表时间：
1996-03-01
影响因子：
3.7
通讯作者：
Covan, EK
中科院分区：
文献类型：
--
作者：
Kotwall, CA;Maxwell, JG;Covan, EK
背景资料：临床研究表明，早期乳腺癌保乳手术（BCS）和乳房切除术的生存率相当;然而，BCS的生存率仍然很低。本研究的目的是确定（a）BCS的患病率在区域医疗中心，（B）与BCS的临床病理因素，（c）患者的看法的治疗决策processing.Methods：我们回顾性分析了251例连续乳腺癌病例在1990年1月至1991年12月，77例患者不符合BCS，因为不利的病理。然后，我们采访了118的160名妇女可用于interview.Results：BCS进行了31个符合条件的患者（18%）。多变量分析显示，肿瘤大小< 10 mm（p = 0.03）是BCS的唯一显著预测变量。患者访谈显示，93%的患者表示他们的外科医生是有关治疗方案的主要信息来源。据报道，在69%的女性中，外科医生推荐了一种特定的选择，89%的女性推荐了乳房切除术，93%的女性顺从了乳房切除术，11%的女性推荐了BCS，89%的女性顺从了BCS。（p = 0.04），60%的人说他们自己做了决定，而乳房切除术组只有37%。结论：将BCS限制于肿瘤大小< 10 mm的女性过于严格;这排除了大量临床上适合BCS的女性。早期乳腺癌的手术决策过程在很大程度上是由外科医生驱动的，患者的依从性很高。
Background: Clinical studies have shown equivalent survival rates between breast-conserving surgery (BCS) and mastectomy in early breast cancer; however, rates for BCS remain low. The purpose of this study was to determine (a) the prevalence of BCS in a regional medical center, (b) clinicopathologic factors associated with BCS, and (c) patient perceptions of the treatment decision-making process.Methods: We retrospectively reviewed 251 consecutive breast cancer cases during January 1990-December 1991; 77 patients were ineligible for BCS because of unfavorable pathology. We then interviewed 118 of the 160 women available for interview.Results: BCS was performed in 31 of the eligible patients (18%). Multivariate analysis revealed that tumor size < 10 mm (p = 0.03) was the only significant predictive variable for BCS. Patient interviews revealed that 93% said their surgeon was the primary source of information regarding treatment options. Among 69% of the women whose surgeons reportedly recommended a particular option, 89% recommended mastectomy with 93% compliance, and 11% recommended BCS with 89% compliance, The BCS group more often obtained a second opinion (p = 0.04) and 60% said they made the decision themselves compared with only 37% of the mastectomy group (p = 0.05).Conclusion: Limiting BCS to women whose tumor size is < 10 mm is too restrictive; this excludes a large number of women who are clinically eligible for BCS. The surgical decision-making process for early-stage breast cancer is very much surgeon-driven, with a high degree of patient compliance.