Vaz-Luis Ines, Hughes Melissa E, Cronin Angel, Rugo Hope S, Edge Stephen B, Moy Beverly, Theriault Richard L, Hassett Michael J, Winer Eric P, Lin Nancy U
Dana-Farber Cancer Institute, Boston, MA, USA.
San Francisco Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA.
Breast Cancer Res Treat. 2016 Feb;155(3):569-78. doi: 10.1007/s10549-016-3707-1. Epub 2016 Feb 11.
Breast-conserving surgery (BCS) provides equivalent survival outcomes to unilateral mastectomy. There is no survival advantage to bilateral mastectomy in average risk breast cancer. Among a cohort of breast cancer patients expected to be candidates for BCS, we examined choice of surgery and factors associated with it. A prospective cohort study of unilateral clinical Stage I breast cancer patients treated at National Comprehensive Cancer Network centers from 2000 to 2009 was performed. The proportion of patients who initially underwent mastectomy versus BCS and time to definitive surgery and chemotherapy were examined. Of 10,249 patients, 23 % underwent mastectomy as an initial surgery. No decline in the use of mastectomy as initial surgery was found. There was significant institutional variation, with rates of initial mastectomy ranging from 14 to 30 % (adjusted odds ratio: 0.42-1.38). Tumor characteristics were associated with surgical option, but with small absolute differences. Of those who received initial mastectomy, 22 % had bilateral mastectomy, with an increase over time (2000:13 % vs. 2009:30 %) and substantial institutional variation (11-34 %). Women treated with initial mastectomy had longer median times from diagnosis to complete definitive surgery (6 vs. 4 weeks) and to start of adjuvant chemotherapy (12 vs. 11 weeks). Among Stage I breast cancer, the overall use of mastectomy did not change significantly over 10 years; however, an increasing proportion of women with unilateral cancer had bilateral mastectomy, and there was wide variation in type of surgery by institution. Further studies to assess reasons for the observed wide variation are warranted.
保乳手术（BCS）与单侧乳房切除术的生存结果相当。对于平均风险的乳腺癌患者，双侧乳房切除术并无生存优势。在一组有望成为保乳手术候选者的乳腺癌患者中，我们研究了手术选择及其相关因素。对2000年至2009年在国家综合癌症网络中心接受治疗的单侧临床I期乳腺癌患者进行了一项前瞻性队列研究。研究了最初接受乳房切除术与保乳手术的患者比例以及确定手术和化疗的时间。在10249名患者中，23%的患者最初接受了乳房切除术。未发现最初选择乳房切除术的比例有所下降。机构之间存在显著差异，最初乳房切除术的比例在14%至30%之间（调整后的优势比：0.42 - 1.38）。肿瘤特征与手术选择相关，但绝对差异较小。在最初接受乳房切除术的患者中，22%进行了双侧乳房切除术，且随着时间推移有所增加（2000年：13% vs. 2009年：30%），机构之间也存在很大差异（11% - 34%）。最初接受乳房切除术的女性从诊断到完成确定性手术的中位时间（6周 vs. 4周）以及开始辅助化疗的中位时间（12周 vs. 11周）更长。在I期乳腺癌患者中，乳房切除术的总体使用在10年内没有显著变化；然而，单侧癌症患者中进行双侧乳房切除术的比例在增加，并且不同机构的手术类型差异很大。有必要进一步研究以评估观察到的广泛差异的原因。
