乳腺癌保留乳房手术选择影响因素分析

目的保留乳房手术已成为国际上早期乳腺癌患者首选的手术方式,但仍有一部分符合保留乳房手术条件的患者选择乳房切除手术,因此本研究分析符合保留乳房手术条件的早期乳腺癌患者保留乳房手术选择的影响因素。方法选取2017-07-01-2018-12-31于西南医科大学附属医院病理确诊为乳腺癌并且符合入组标准的314例患者作为研究对象,采用问卷调查的方式收集相关资料,将整理的资料进行赋值后采用单因素分析,再将有意义的因素采用二元Logistic回归方法进行多因素分析。结果共发放问卷308份,收回有效问卷287份,有效回收率为93.2%。单因素分析结果显示,早期乳腺癌患者保留乳房手术组(159例)与乳房切除手术组(128例)相比,临床Ⅰ和Ⅱ期(χ^2=11.429,P=0.001)、是否工作(χ^2=4.608,P=0.032)、癌症家族史(χ^2=5.791,P=0.016)、乳腺良性疾病史(χ^2=7.431,P=0.006)、居住地距医疗中心的距离(χ^2=22.257,P<0.001)、外科医生建议(χ^2=9.053,P=0.029)、住院费用(χ^2=11.505,P=0.009)以及放疗因素(χ^2=8.313,P=0.040)是影响患者是否选择保留乳房手术的因素。二元Logistic回归方法多因素分析后发现,有癌症家族史(OR=7.612,95%CI为2.225~26.040,P=0.001)、乳腺良性疾病史(OR=7.382,95%CI为2.205~24.718,P=0.001)和外科医生建议手术切除(OR=9.264,95%CI为4.326~19.836,P<0.001)与患者选择乳房切除手术有关联。居住地距治疗中心的距离(OR=0.198,95%CI为0.077~0.509,P=0.001)及放疗因素(OR=0.194,95%CI为0.065~0.579,P=0.003)与患者选择保留乳房手术有关联。结论医疗因素及患者自身因素均能影响符合保留乳房手术条件乳腺癌患者手术方式的选择,作为医务人员,应根据患者具体情况给予积极的引导。

Analysis of factors influencing the choice of breast-conserving surgery for breast cancer

OBJECTIVE Breast-conserving surgery has become the preferred surgical method for early breast cancer patients in the world,but there are still some patients eligible for breast-conserving surgery choosing mastectomy.This study analyzed the factors related to the selection of breast-conserving surgery in patients with early breast cancer who were eligible for breast-conserving surgery.METHODS Totally 314 patients who were diagnosed with breast cancer in the Affiliated Hospital of Southwest Medical University from July 1,2017 to December 31,2018 and met the inclusion criteria were selected as subjects.Questionnaires were used to collect relevant data,and the collected data were assigned to be univariate analysis.The meaningful factors were analyzed by multivariate analysis using binary Logistic Regression method.RESULTS A total of 308 questionnaires were distributed in this study and 287 valid questionnaires were returned.The effective recovery rate was 93.2%.Univariate analysis showed that the breast-conserving surgery group(159 cases)compared with the mastectomy group(128 cases),clinical stageⅠ,Ⅱ (χ^2=11.429,P=0.001),work status(χ^2=4.608,P=0.032),family history of cancer(χ^2=5.791,P=0.016),history of benign breast disease(χ^2=7.431,P=0.006),distance from the treatment center(χ^2=22.257,P<0.001),surgeon’s recommendation(χ^2=9.053,P=0.029),hospitalization cost(χ^2=11.505,P=0.009)and radiotherapy(χ^2=8.313,P=0.040)were the factors affecting patient’s chose for breast-conserving surgery.Multivariate analysis using binary Logistic Regression showed that family history of cancer(OR=7.612,95% CI:2.225-26.040,P=0.001),history of benign breast disease(OR=7.382,95% CI:2.205-24.718,P=0.001)and surgeons recommendation of surgical resection(OR=9.264,95% CI:4.326-19.836,P<0.001)were associated with selective mastectomy.Distance from the treatment center(OR=0.198,95% CI:0.077-0.509,P=0.001)and radiotherapy(OR=0.194,95% CI:0.065-0.579,P=0.003)were associated with selective breast-conserving surgery.CONCLUSIONS Both medical factors and patient factors may affect the choice of surgical methods for breast cancer patients who meet the requirements of breast-conserving conditions.As medical personnel,the most appropriate treatment plan for patients should be selected according to the specific conditions of patients.