Musallam Rami, Alnajjar Mohammed, Al-Shurafa Ahmad, Bottcher Bettina
Ministry of Health, Gaza, occupied Palestinian territory.
Ministry of Health, Gaza, occupied Palestinian territory.
Lancet. 2021 Jul;398 Suppl 1:S38. doi: 10.1016/S0140-6736(21)01524-5.
Breast cancer is the most common cancer (accounting for 31·3% of all cancers) among women in the Gaza Strip. This audit examines clinical and pathological characteristics of women presenting with breast carcinoma to the European Gaza Hospital (EGH), a governmental hospital and oncological centre serving 600 000 people in the southern Gaza Strip.
Data were collected from the records of patients with breast cancer treated at the EGH from March, 2015, to Sept, 2017. 397 cases were identified, including 218 patients with full hormone receptor status (oestrogen, progesterone, and Her2/neu receptor status). Data were analysed using Student's t test.
The mean age was 54 years (SD 11·2). 64% of the women (139 of 218) were older than 50 years, and 16% (33 of 218) were younger than 40 years. Histological grade was assessed for 56% of the women (122 of 218), and 55% of these women (67 of 122) presented with grade II tumours. Tumour size was documented in 82% of the files (178 of 218), and tumours were 2-5 cm in 47% of the documented cases (83 of 178). Furthermore, 51% of women (112 of 218) tested positive for the presence of cancer cells in lymph nodes, and 6% (14 of 218) had distant metastasis at presentation. The clinical stage at diagnosis was recorded in 56% of cases (122 of 218), of whom 4% (five of 122) presented at stage I, 54% (66 of 122) presented at stage II, and 42% (51 of 122) presented at stage III/IV. Pre-operative histopathology was carried out for 120 women, of whom 85% (102 of 120) had intraductal carcinoma. Only 81% of women (177 of 218) had post-operative histopathology, of whom 79% (139 of 177) had intraductal carcinoma. The histopathological type was significantly different for pre-operative and post-operative specimens (p<0·0001). Oestrogen receptor status was positive in 58% of patients (127 of 218), progesterone receptor status was positive in 57% of patients (124), and HER2/neu receptor was overexpressed in 33% of patients (65). Triple-negative breast cancer (testing negative for oestrogen, progesterone, and HER2/neu) was found in 23% of the women (49) and double-negative breast cancer (testing negative for oestrogen and progesterone but positive for HER2) in 11% of the women (24).
Patients with breast cancer present with advanced disease in the Gaza Strip. HER2/neu overexpression was approximately 10% higher than the percentages reported in the literature for the USA. The significant difference between pre-operative and post-operative specimens' histopathological type could be due to use of fine-needle aspiration. Guidance from the Royal College of Radiologists recommends pre-operative core biopsy. It should be noted that documentation in the patient medical files was incomplete, which is a common obstacle in Gaza that must be tackled for effective improvement in the quality of care.
None.
乳腺癌是加沙地带女性中最常见的癌症（占所有癌症的31.3%）。本次审计调查了前往欧洲加沙医院（EGH）就诊的乳腺癌女性患者的临床和病理特征，该医院是一家为加沙地带南部60万人口服务的政府医院和肿瘤中心。
收集了2015年3月至2017年9月在EGH接受治疗的乳腺癌患者的记录。共识别出397例病例，其中218例患者的激素受体状态（雌激素、孕激素和Her2/neu受体状态）完整。数据采用学生t检验进行分析。
平均年龄为54岁（标准差11.2）。64%的女性（218例中的139例）年龄超过50岁，16%（218例中的33例）年龄小于40岁。对56%的女性（218例中的122例）进行了组织学分级评估，其中55%的女性（122例中的67例）为II级肿瘤。82%的病历（218例中的178例）记录了肿瘤大小，47%的记录病例（178例中的83例）肿瘤大小为2 - 5厘米。此外，51%的女性（218例中的112例）淋巴结中癌细胞检测呈阳性，6%（218例中的14例）初诊时已有远处转移。56%的病例（218例中的122例）记录了诊断时的临床分期，其中4%（122例中的5例）为I期，54%（122例中的66例）为II期，42%（122例中的51例）为III/IV期。120名女性进行了术前组织病理学检查，其中85%（120例中的102例）为导管内癌。只有81%的女性（218例中的177例）有术后组织病理学检查结果，其中79%（177例中的139例）为导管内癌。术前和术后标本的组织病理学类型有显著差异（p<0.0001）。58%的患者（218例中的127例）雌激素受体状态为阳性，57%的患者（124例）孕激素受体状态为阳性，33%的患者（65例）HER2/neu受体过度表达。23%的女性（49例）为三阴性乳腺癌（雌激素、孕激素和HER2/neu检测均为阴性），11%的女性（24例）为双阴性乳腺癌（雌激素和孕激素检测为阴性，但HER2检测为阳性）。
加沙地带的乳腺癌患者就诊时病情已属晚期。HER2/neu过度表达比美国文献报道的百分比约高10%。术前和术后标本组织病理学类型的显著差异可能是由于使用了细针穿刺。英国皇家放射科医师学院的指南推荐术前进行粗针活检。需要注意的是，患者病历记录不完整，这是加沙地区普遍存在的障碍，必须加以解决才能有效提高医疗质量。
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