Kelemen J J, Poulton T, Swartz M T, Jatoi I
Department of Surgery, Saint Louis University, St Louis, MO 63110, USA.
J Am Coll Surg. 2001 Mar;192(3):293-7. doi: 10.1016/s1072-7515(00)00803-6.
The choice between breast-conserving surgery and modified radical mastectomy in the treatment of women with early stage breast cancer in the Department of Defense Healthcare System may be influenced by demographic factors.
The Department of Defense Automated Central Tumor Registry (ACTUR) was queried for women diagnosed with American Joint Committee on Cancer Stage I or II invasive breast carcinoma from January 1, 1986, to December 31, 1996. Univariate analysis and multivariate analysis were applied to the study variables. Year of diagnosis, age at diagnosis, tumor size, type of hospital, geographic region, and local availability of radiation therapy were evaluated with respect to the type of surgical treatment performed. Surgical treatment was either breast conservation therapy (BCT) or modified radical mastectomy.
After excluding women for whom the data were incomplete (n = 308), 7,815 women were identified who met study criteria. There was a progressive increase in the use of BCT to treat tumors of all sizes from 16% to 47% over the 11 years of the study (p < 0.0001). BCT was more frequently used for smaller tumors (< 2cm), with an odds ratio of 2.46 (2.20-2.76, 95% CI). In 1996, 54% of women with T1 (< 2 cm) tumors were treated with BCT. Women treated with BCT were nearly the same age as those undergoing modified radical mastectomy (55.5 years versus 56.8 years, p < 0.0001). BCT was used at a slightly greater rate in medical centers than in community hospitals (31% versus 28%, p < 0.0001). Use of BCT varied among geographic regions from a low of 24% in the southwestern USA to a peak of 36% in the Northeast and 40% in hospitals outside of the continental United States (p < 0.0001). Local availability of radiation therapy did not influence choice of treatment.
The use of BCT to treat early stage invasive breast carcinoma in the Department of Defense Healthcare System is increasing. But BCT is used less often to treat larger tumors. Regional differences in the use of BCT persist, even after controlling for other factors. Patient age and type of hospital (community versus academic center) appear to exert little influence on the choice of treatment. Local availability of radiation therapy did not seem to influence the choice of treatment. Our data suggest that efforts to promote the use of BCT should target the central and southwestern USA. Use of BCT should also be emphasized for women with larger tumors (> 2 cm).
在国防部医疗系统中，早期乳腺癌女性患者的保乳手术和改良根治性乳房切除术之间的选择可能会受到人口统计学因素的影响。
查询国防部自动化中央肿瘤登记处（ACTUR），以获取1986年1月1日至1996年12月31日期间被诊断为美国癌症联合委员会I期或II期浸润性乳腺癌的女性患者信息。对研究变量进行单因素分析和多因素分析。根据所实施的手术治疗类型，评估诊断年份、诊断时年龄、肿瘤大小、医院类型、地理区域以及放疗的当地可及性。手术治疗方式为保乳治疗（BCT）或改良根治性乳房切除术。
在排除数据不完整的女性患者（n = 308）后，确定了7815名符合研究标准的女性患者。在研究的11年中，使用BCT治疗各种大小肿瘤的比例从16%逐步增加到47%（p < 0.0001）。BCT更常用于较小的肿瘤（< 2cm），优势比为2.46（2.20 - 2.76，95%置信区间）。1996年，54%的T（< 2cm）期肿瘤女性患者接受了BCT治疗。接受BCT治疗的女性患者年龄与接受改良根治性乳房切除术的女性患者年龄几乎相同（55.5岁对56.8岁，p < 0.0001）。医疗中心使用BCT的比例略高于社区医院（31%对28%，p < 0.0001）。BCT的使用在不同地理区域有所差异，在美国西南部低至24%，在东北部最高达36%，在美国大陆以外的医院为40%（p < 0.0001）。放疗的当地可及性并未影响治疗选择。
在国防部医疗系统中，使用BCT治疗早期浸润性乳腺癌的比例正在增加。但BCT较少用于治疗较大的肿瘤。即使在控制了其他因素后，BCT使用的区域差异仍然存在。患者年龄和医院类型（社区医院与学术中心）似乎对治疗选择影响不大。放疗的当地可及性似乎并未影响治疗选择。我们的数据表明，促进BCT使用的努力应针对美国中部和西南部地区。对于肿瘤较大（> 2cm）的女性患者，也应强调使用BCT。
