比较意大利和中国绝经前乳腺癌的临床病理特征及外科治疗：一项医学交流项目的报告
Comparing Clinicopathologic Features and Surgical Treatment of Premenopausal Breast Cancer across Italy and China: Report from a Medical Exchange Program.
作者信息
Fancellu Alessandro, Zhao Xue Yun, Cottu Pietrina, Sanna Valeria, Li Yuan Ping, Zhu Qin, Tanda Cinzia, Zhang Ying Yi, Lai Yan Mei, Ginesu Giorgio Carlo, Dai Shu Qin, Porcu Alberto
机构信息
Unit of General Surgery 2-Clinica Chirurgica, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.
Department of Thyroid and Breast Surgery, People's Hospital of Leshan, Leshan, China.
出版信息
Breast Care (Basel). 2020 Oct;15(5):511-518. doi: 10.1159/000505448. Epub 2020 Jan 21.
BACKGROUND
This study investigated the differences in clinicopathologic features and surgical treatment between an Italian and a Chinese cohort of premenopausal women with breast cancer, and highlighted the potential advantages of international medical exchange projects.
METHODS
Premenopausal women who underwent surgical treatment between 2012 and 2016 at one Italian and one Chinese institution participating in a medical exchange program were compared. Factors associated with the probability to receive mastectomy were determined via logistic analysis. Changes in surgical management at the Chinese institution in the period 2018-2019, after the exchange program, were also evaluated.
RESULTS
A total of 505 patients, 318 from Italy and 187 from China, were evaluated. The Chinese patients had more frequently advanced-stage tumours, large tumour size (30.9 vs. 18.1 mm, < 0.01), invasive carcinoma (92.5 vs. 83.3%, < 0.01), positive axillary lymph nodes (54.5 vs. 27.4%, < 0.01), Her-2 positivity (36.4 vs. 22.0%, < 0.01), and high proliferative index (55.1 vs. 30.2%, < 0.01). Positive oestrogen receptor status and rates of triple-negative breast cancer did not differ (77.0 vs. 69.5%, = 0.09 and 14.2 vs. 16%, = 0.56, respectively). Mastectomy rates were higher among Chinese women (85 vs. 41%, < 0.001), whereas use of sentinel node biopsy was more frequent among Italian women (77 vs. 33%, < 0.001). Chinese women had more than 4-fold higher risk of receiving mastectomy. In the last 2 years, the rates of breast-conserving surgery and sentinel node biopsy at the Chinese institution increased from 15 to 23%, and from 33 to 42%, respectively.
CONCLUSIONS
Tumour features and surgical strategies for premenopausal breast cancer may differ significantly between Italy and China. Since the international exchange program, patients from the Chinese institution have been offered more frequently less invasive surgery. International exchange programs can help in designing epidemiological studies which may be useful for strategies to improve breast cancer management and control.
背景
本研究调查了意大利和中国绝经前乳腺癌女性队列在临床病理特征和手术治疗方面的差异，并强调了国际医学交流项目的潜在优势。
方法
对2012年至2016年期间在参与医学交流项目的一家意大利机构和一家中国机构接受手术治疗的绝经前女性进行了比较。通过逻辑分析确定与接受乳房切除术概率相关的因素。还评估了交流项目后中国机构在2018 - 2019年期间手术管理的变化。
结果
共评估了505例患者，其中318例来自意大利，187例来自中国。中国患者的晚期肿瘤、肿瘤较大（30.9对18.1毫米，<0.01）、浸润性癌（92.5%对83.3%，<0.01）、腋窝淋巴结阳性（54.5%对27.4%，<0.01）、Her-2阳性（36.4%对22.0%，<0.01）以及高增殖指数（55.1%对30.2%，<0.01）更为常见。雌激素受体阳性状态和三阴性乳腺癌的发生率没有差异（分别为77.0%对69.5%，P = 0.09和14.2%对16%，P = 0.56）。中国女性的乳房切除术率更高（85%对41%，<0.001），而意大利女性更频繁地使用前哨淋巴结活检（77%对33%，<0.001）。中国女性接受乳房切除术的风险高出4倍多。在过去两年中，中国机构的保乳手术率和前哨淋巴结活检率分别从15%提高到23%和从33%提高到42%。
结论
意大利和中国绝经前乳腺癌的肿瘤特征和手术策略可能存在显著差异。自国际交流项目开展以来，中国机构的患者更频繁地接受了侵入性较小的手术。国际交流项目有助于设计流行病学研究，这可能对改善乳腺癌管理和控制策略有用。
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