Department of Breast Surgery, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
Department of Breast Surgery, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
J Surg Res. 2019 Jul;239:224-232. doi: 10.1016/j.jss.2019.02.002. Epub 2019 Mar 8.
The aim of this study was to evaluate the trends of surgical treatments among young patients in TNM stage based on the Surveillance, Epidemiology, and End Results database.
Patients aged less than 40 y diagnosed between 1998 and 2015 were enrolled, with tumors in TNM stage and not located in the central area. Differences in clinical-pathological characteristics were evaluated using chi-square tests. Multivariate logistic regression was used to measure the various factors associated with contralateral prophylactic mastectomy (CPM). Independent prognostic factors were evaluated by Cox model.
The total rate of breast-conserving surgery (BCS) was 51.6%, which declined from 64.5% in 1998 to 39.6% in 2015. The total rate of CPM was 22.7%, which increased from 3.7% in 1998 to 38.7% in 2014 despite a decline to 32.7% in 2015. Meanwhile, the rate of reconstruction increased in line with that of CPM, from 9.4% in 1998 to 35.0% in 2015. There was a trend of increasing use of implant-based reconstruction. Significant higher odds of CPM were found in recent year of diagnosis between 2010 and 2015 and in implant-based reconstruction. Patients undergoing CPM had similar survival outcomes compared with those undergoing BCS and unilateral mastectomy, whereas those undergoing BCS had better survival outcomes compared with those undergoing unilateral mastectomy.
A trend of growing preference for CPM and reconstruction was observed among young patients in early stage in recent years without survival benefits. Efforts should be made to promote efficient communication and evidence-based decision-making.
本研究旨在通过监测、流行病学和最终结果数据库评估基于 TNM 分期的年轻患者的手术治疗趋势。
纳入了 1998 年至 2015 年间诊断为年龄小于 40 岁且肿瘤处于 TNM 分期且不在中央区域的患者。使用卡方检验评估临床病理特征差异。多变量逻辑回归用于测量与对侧预防性乳房切除术（CPM）相关的各种因素。使用 Cox 模型评估独立预后因素。
保乳手术（BCS）的总比率为 51.6%，从 1998 年的 64.5%下降到 2015 年的 39.6%。CPM 的总比率为 22.7%，从 1998 年的 3.7%增加到 2014 年的 38.7%，尽管 2015 年下降到 32.7%。同时，重建率与 CPM 同步增加，从 1998 年的 9.4%增加到 2015 年的 35.0%。使用植入物为基础的重建的趋势增加。在诊断的最近年份 2010 年至 2015 年和植入物为基础的重建中，CPM 的可能性更高。与 BCS 和单侧乳房切除术相比，接受 CPM 的患者的生存结果相似，而与单侧乳房切除术相比，接受 BCS 的患者的生存结果更好。
近年来，早期年轻患者中 CPM 和重建的趋势越来越大，但没有生存获益。应努力促进有效的沟通和基于证据的决策。
