Department of Radiation Oncology, James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY 40202, USA.
Breast J. 2012 Jul-Aug;18(4):318-25. doi: 10.1111/j.1524-4741.2012.01245.x. Epub 2012 May 21.
First-line surgical options for early stage breast cancer and ductal carcinoma in situ include breast conserving surgery or mastectomy. We analyzed factors that influence the receipt of mastectomy and resultant trends over time. Registry analysis was carried out for 21,869 women who underwent up-front surgical treatment for stage 0, I or II breast cancer between 1998 and 2007 using data from the Kentucky Cancer Registry. We examined the trend of treatment over time and assessed the probability of receiving mastectomy using multivariate logistic regression. Overall, 54.5% of women received breast conservation and 45.5% received mastectomy over a 10-year period (annual BCS rate range: 46.9-61.2%). The overall mastectomy rate substantially decreased from 53.1% in 1998 to 38.8% in 2005 (p < 0.0001), but then increased to 45% in 2007 (p < 0.001). Between 2005 and 2007, the increase in mastectomies in the age groups of <50 years, 50-69 years, and ≥ 70 years was 7.5% (p = 0.0351), 4.9% (p = 0.0132) and, 8.0% (p = 0.0283), respectively. On multivariate analysis, the rate of receiving mastectomy was drastically higher for women with stage I or II (versus in situ) disease and moderate or poorly differentiated (versus well differentiated) histology. The rate was modestly higher for uninsured and government-insured (versus privately insured) patients, patients older than 70 years (versus younger), rural (versus urban) location, receptor negative (versus receptor positive) disease, and unusual histologies (versus ductal and lobular histology). There was no statistically significant difference in surgical choice with regard to race. Determinants of mastectomy for in situ and early stage breast cancer include stage, histology, age, insurance status, county of residence, receptor status. The rate of mastectomy declined until 2005 and is now increasing across all age groups, especially for women < 50 years and ≥ 70 years.
早期乳腺癌和导管原位癌的一线手术选择包括保乳手术或乳房切除术。我们分析了影响接受乳房切除术的因素及其随时间的变化趋势。对 1998 年至 2007 年间接受 0 期、I 期或 II 期乳腺癌 upfront 手术治疗的 21869 名女性进行了注册分析，数据来自肯塔基癌症登记处。我们检查了随时间推移的治疗趋势，并使用多变量逻辑回归评估了接受乳房切除术的概率。总体而言，在 10 年内，54.5%的女性接受了保乳治疗，45.5%的女性接受了乳房切除术（年度 BCS 率范围：46.9-61.2%）。整体乳房切除术率从 1998 年的 53.1%大幅下降到 2005 年的 38.8%（p<0.0001），但随后在 2007 年上升至 45%（p<0.001）。在 2005 年至 2007 年期间，<50 岁、50-69 岁和≥70 岁的年龄组中乳房切除术的增加分别为 7.5%（p=0.0351）、4.9%（p=0.0132）和 8.0%（p=0.0283）。多变量分析显示，患有 I 期或 II 期（与原位癌相比）疾病和中度或低度分化（与高度分化相比）组织学的女性接受乳房切除术的比率明显更高。无保险和政府保险（与私人保险相比）、年龄>70 岁（与年轻）、农村（与城市）、受体阴性（与受体阳性）疾病和不常见组织学（与导管和小叶组织学相比）的患者的比率略高。种族在手术选择方面没有统计学上的显著差异。原位和早期乳腺癌乳房切除术的决定因素包括分期、组织学、年龄、保险状况、居住地县、受体状态。乳房切除术的比率在 2005 年之前下降，现在在所有年龄组中都在增加，尤其是<50 岁和≥70 岁的女性。
