Balabram Débora, Araújo Fábio Braga, Porto Simone Souza, Rodrigues Joyce Soares, Sousa Atila Silva, Siqueira Arminda Lucia, Gobbi Helenice
Department of Anatomical Pathology, Universidade Federal de Minas Gerais, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Sao Paulo Med J. 2012;130(6):360-6. doi: 10.1590/s1516-31802012000600002.
Recently, breast-conserving surgery (BCS) has been replacing mastectomy for breast cancer treatment. The aim of this study was to evaluate the changes in mastectomy and BCS rates and the factors relating to these shifts.
A retrospective study in a Brazilian public hospital.
Pathological records from female patients who underwent surgery for breast cancer at Hospital das Clínicas, Universidade Federal de Minas Gerais (HC-UFMG), between 1989 and 2008 were reviewed. The mastectomy and BCS rates were calculated. The chi-square test was used to assess factors associated with type of surgical treatment and to compare trends in treatment type over the years. Logistic regression was used for multivariate analysis.
From 1989 to 2008, 2050 breast cancer surgical specimens were received in our service, corresponding to 1973 patients; 1324 (64.6%) of them were from mastectomy and 726 (35.4%) from BCS. A shift from mastectomy towards BCS was observed (P < 0.001). In multivariate analysis, earlier year of surgery (P < 0.001), larger tumor size (P < 0.001), having at least one positive axillary lymph node (P < 0.001) and patients' age greater than 68 years (P = 0.007) were predictors of mastectomy.
There was a shift from mastectomy towards BCS in our institution over the years. This may reflect consolidation of BCS (plus radiotherapy) as an equivalent treatment to mastectomy in terms of survival and a shift to earlier diagnosis for the disease.
近年来，保乳手术（BCS）已逐渐取代乳房切除术用于乳腺癌治疗。本研究旨在评估乳房切除术和保乳手术率的变化以及与这些变化相关的因素。
在巴西一家公立医院进行的回顾性研究。
回顾了1989年至2008年间在米纳斯吉拉斯联邦大学临床医院（HC-UFMG）接受乳腺癌手术的女性患者的病理记录。计算了乳房切除术和保乳手术率。采用卡方检验评估与手术治疗类型相关的因素，并比较多年来治疗类型的趋势。使用逻辑回归进行多变量分析。
1989年至2008年，我们共接收了2050份乳腺癌手术标本，对应1973例患者；其中1324例（64.6%）来自乳房切除术，726例（35.4%）来自保乳手术。观察到从乳房切除术向保乳手术的转变（P < 0.001）。在多变量分析中，手术年份较早（P < 0.001）、肿瘤尺寸较大（P < 0.001）、至少有一个腋窝淋巴结阳性（P < 0.001）以及患者年龄大于68岁（P = 0.007）是乳房切除术的预测因素。
多年来，我们机构从乳房切除术向保乳手术发生了转变。这可能反映出保乳手术（加放疗）在生存方面已成为与乳房切除术等效的治疗方法，以及疾病诊断向早期的转变。
