Pan Hsueh-Hsing, Chu Chun-Hui, Wu Li-Fen, Hsieh Pi-Ching, Chang Kun-Chia, Li Chung-Yi
From the School of Nursing, National Defense Medical Center, Taipei, Taiwan (H-HP, L-FW); Department and Institute of Public Health, College of Medicine, National Cheng-Kung University, Tainan, Taiwan (C-HC, K-CC, C-YL); Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan (L-FW); Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan (P-CH); Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan, Taiwan (K-CC); and Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan (C-YL).
Medicine (Baltimore). 2016 Jan;95(3):e2510. doi: 10.1097/MD.0000000000002510.
This study used Taiwan's National Health Insurance medical claims to investigate the predictors for operative modes chosen by early-stage breast cancer patients; as well as to assess whether operative modes are associated with risk of mood disorder. We included 36,377 patients with breast cancer who received surgery between 2000 and 2008, and were followed to the end of 2010; they were further classified into 3 groups: mastectomy alone (n = 34,900), along with early reconstruction (n = 1080), and along with delayed reconstruction (n = 397). The results showed that age, insurance premium, urbanization level, and postsurgery chemotherapy and radiotherapy were all significant predictors for the selection of operative modes. Breast cancer patients with mastectomy alone, early reconstruction, and delayed reconstruction showed a cumulative incidence rate of mood disorder of 36.90%, 41.56%, and 33.89%, respectively. The multiple cox proportional model further revealed that early (hazard ratio [HR] = 1.06, 95% confidence interval (CI) = 0.93-1.21) and delayed (HR = 1.17, 95% CI = 0.96-1.42) reconstruction were associated with a slightly higher but insignificant risk of mood disorder, as compared to the patients received no reconstruction.
本研究利用台湾地区国民健康保险医疗理赔数据，调查早期乳腺癌患者手术方式的预测因素；并评估手术方式是否与情绪障碍风险相关。我们纳入了2000年至2008年间接受手术且随访至2010年底的36377例乳腺癌患者；这些患者进一步分为3组：单纯乳房切除术组（n = 34900）、同期乳房重建组（n = 1080）和延期乳房重建组（n = 397）。结果显示，年龄、保险费、城市化水平以及术后化疗和放疗都是手术方式选择的显著预测因素。单纯乳房切除术、同期乳房重建和延期乳房重建的乳腺癌患者情绪障碍累积发生率分别为36.90%、41.56%和33.89%。多因素Cox比例模型进一步显示，与未进行乳房重建的患者相比，同期（风险比[HR]=1.06，95%置信区间[CI]=0.93 - 1.21）和延期（HR = 1.17，95% CI = 0.96 - 1.42）乳房重建与情绪障碍风险略有升高但无统计学意义相关。
