Kapoor Trishul, Wrenn Sean, Callas Peter, James Ted A
Mayo Clinic, Department of Surgery, Rochester, MN, USA.
University of Vermont Medical Center, Department of Surgery, Burlington, VT, USA.
Breast Dis. 2017;37(2):77-82. doi: 10.3233/BD-170288.
After primary surgical resection, breast cancer survivors regularly undergo surveillance using multiple modalities to detect recurrences.
The goal of this study was to determine how breast cancer recurrences were detected in our sample population of breast cancer survivors. We hypothesize that the majority of recurrences are patient-detected.
This was a retrospective observational study evaluating patients with a detected breast cancer recurrence between 2010 and 2015. Patients were analyzed by initial detection modality (patient versus clinician versus imaging). Other variables of interest included insurance status, ambulation capability, living situation, age at diagnosis and recurrence, and time to recurrence. Statistical methods included chi-square tests, log-rank tests, and analysis of variance.
115 patients were identified with a recurrence (mean age 61 years). 88 (77%) recurrences were patient-detected, 14 (12%) were detected by imaging, and 13 (11%) were clinician-detected (chi-square goodness of fit test p < 0.001). Median time to recurrence was 4 years in the patient-detection group compared to 3 for the clinician group and 2 for imaging detection (log-rank test p = 0.01).
While the majority of recurrences were patient-detected, these were detected later and at a more advanced clinical stage. This could represent an opportunity to enhance outcomes by empowering patient detection strategies.
在进行初次手术切除后，乳腺癌幸存者需定期接受多种方式的监测以检测复发情况。
本研究的目的是确定在我们的乳腺癌幸存者样本群体中，乳腺癌复发是如何被检测到的。我们假设大多数复发是由患者自己发现的。
这是一项回顾性观察研究，评估了2010年至2015年间检测到乳腺癌复发的患者。通过初始检测方式（患者、临床医生、影像学）对患者进行分析。其他感兴趣的变量包括保险状况、行走能力、生活状况、诊断和复发时的年龄以及复发时间。统计方法包括卡方检验、对数秩检验和方差分析。
共识别出115例复发患者（平均年龄61岁）。88例（77%）复发是由患者自己发现的，14例（12%）是通过影像学检测到的，13例（11%）是由临床医生检测到的（卡方拟合优度检验p<0.001）。患者发现组的复发中位时间为4年，临床医生组为3年，影像学检测组为2年（对数秩检验p = 0.01）。
虽然大多数复发是由患者自己发现的，但这些复发被发现的时间较晚，且处于更晚期的临床阶段。这可能代表了一个通过加强患者检测策略来改善治疗结果的机会。
