Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands; Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.
Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands; Department of Gerontology & Geriatrics, Leiden University Medical Center, Leiden, The Netherlands.
Cancer Treat Rev. 2014 Sep;40(8):1005-18. doi: 10.1016/j.ctrv.2014.06.007. Epub 2014 Jun 23.
Treatment decisions in early breast cancer can revolve around type of surgery and whether or not to have adjuvant systemic therapy. This systematic review aims to give an overview of patient self-reported factors affecting preferences for breast conserving surgery (BCS) versus mastectomy (MAST), the minimal benefit patients require from adjuvant chemotherapy (aCT) and/or adjuvant hormonal therapy (aHT) to consider it worthwhile, and factors influencing this minimally-required benefit.
PubMed and EMBASE were searched for relevant articles. Two reviewers independently selected articles and extracted data.
We identified 15 studies on surgical and six on adjuvant systemic treatment decision-making. Factors affecting patient preference for BCS most frequently related to body image (44%), while factors influencing preference for MAST most often related to survival/recurrence (46%). To make adjuvant systemic therapy worthwhile, the median required absolute increase in survival rate was 0.1-10% and the median required additional life expectancy was 1 day to 5 years. The range of individual preferences was wide within studies. Participants in the aHT studies required larger median benefits than those in the aCT studies. Factors associated with judging smaller benefits sufficient most often (44%) related to quality of life (e.g., less treatment toxicity).
Decisive factors in patients' preferences for surgery type commonly relate to body image and survival/recurrence. Most participants judged small to moderate benefits sufficient to consider adjuvant systemic therapy worthwhile, but individual preferences varied widely. Clinicians should therefore consider the patient's preferences to tailor their treatment recommendations accordingly.
早期乳腺癌的治疗决策可能围绕手术类型以及是否进行辅助全身治疗展开。本系统评价旨在概述影响患者对保乳手术（BCS）与乳房切除术（MAST）偏好的患者报告因素、患者需要从辅助化疗（aCT）和/或辅助激素治疗（aHT）中获得的最小获益以使其获益，以及影响这一最小获益的因素。
在 PubMed 和 EMBASE 上搜索相关文章。两名审查员独立选择文章并提取数据。
我们确定了 15 项关于手术的研究和 6 项关于辅助全身治疗决策的研究。影响患者对 BCS 偏好的因素最常与身体形象有关（44%），而影响对 MAST 偏好的因素最常与生存/复发有关（46%）。为了使辅助全身治疗获益，所需的生存获益的绝对增加中位数为 0.1-10%，所需的额外预期寿命中位数为 1 天至 5 年。研究中个体偏好的范围很广。aHT 研究的参与者比 aCT 研究的参与者需要更大的中位获益。判断较小获益足够的相关因素最常见（44%）与生活质量有关（例如，较少的治疗毒性）。
患者对手术类型偏好的决定性因素通常与身体形象和生存/复发有关。大多数参与者判断小到中等获益足以认为辅助全身治疗获益，但个体偏好差异很大。因此，临床医生应考虑患者的偏好，相应地调整他们的治疗建议。
