2019冠状病毒病大流行：对乳腺癌患者管理的影响；单中心回顾性队列研究。
COVID 19 pandemic: Effect on management of patients with breast cancer; single center retrospective cohort study.
作者信息
Mooghal Mehwish, Javaid Rana Hassan, Khan Wajiha, Muneeb Muhammad, Khan Waseem Ahmad, Ahmad Asrar, Barohi Lal Bux, Rahim Kamran, Tahseen Hina, Gul Amna
机构信息
Department of Surgery, PNS Shifa Hospital, Karachi, Pakistan.
Department of Surgery, Bahria University Medical and Dental College, Karachi, Pakistan.
出版信息
Int J Surg Open. 2021 Sep;35:100386. doi: 10.1016/j.ijso.2021.100386. Epub 2021 Aug 12.
BACKGROUND
(SARS-COV-2) infection, led to a pandemic affecting many countries, resulting in hospitals diverting most of their resources to fight the pandemic. Breast cancer, already a healthcare dilemma, is also affected in this scenario. Our aim was to find out the impact of COVID-19 on presentation of breast cancer stage and its effects on overall onco-surgical management.
METHODS
This cohort single-centered retrospective review was carried out at our hospital, over a period of 18 months. Females with known breast cancer were included in the study. Data was collected on performas by a single researcher. Effect of COVID pandemic on presentation stage and its impact on overall management was studied. SPSS 23.0 used for data analysis. A 95% CI was used. Descriptive statistics were presented as range/means. Categorical data was analyzed by Fisher exact test, -test was applied to numerical data, p value ≤ 0.05 was considered significant.
RESULTS
Out of 87 patients presenting with suspicious lump, 69 who had malignancy on histo-pathology were included in study. Twelve out of 69 were COVID positive. Sixty patients presented with advanced stage (≥stage 2b) out of which 21 underwent upstaging of disease due to delay in presentation/management. We found that 9 out of 12 (majority) Covid positive patients had disease upstaging. Overall main reason for delay in presentation was found to be unawareness of disease.
CONCLUSION
We concluded that COVID-19 pandemic had no impact on presentation delay, breast cancer management/treatment and disease upstaging as compared to figures available for our population before the pandemic. However, our study showed significant correlation between disease upstaging and COVID status. This led us to reconsider our preformed protocols for COVID positive breast cancer patients. Our results can be used by future researchers to investigate if COVID itself can contributes in patho-physiology of upstaging in breast cancer or not.
背景
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染引发了一场影响众多国家的大流行，导致医院将大部分资源用于抗击疫情。乳腺癌本就是一个医疗难题，在这种情况下也受到了影响。我们的目的是了解2019冠状病毒病（COVID-19）对乳腺癌分期表现的影响及其对整体肿瘤外科治疗的影响。
方法
本队列单中心回顾性研究在我院进行，为期18个月。研究纳入了已知患有乳腺癌的女性。数据由一名研究人员通过表格收集。研究了新冠疫情对表现分期的影响及其对整体治疗的影响。使用社会科学统计软件包（SPSS）23.0进行数据分析。采用95%置信区间。描述性统计以范围/均值表示。分类数据采用Fisher精确检验分析，数值数据采用t检验，p值≤0.05被认为具有统计学意义。
结果
在87例出现可疑肿块的患者中，69例组织病理学检查为恶性肿瘤的患者被纳入研究。69例中有12例COVID检测呈阳性。60例患者为晚期（≥2b期），其中21例因就诊/治疗延迟导致疾病分期上调。我们发现，12例COVID阳性患者中有9例（大多数）疾病分期上调。发现就诊延迟的总体主要原因是对疾病不了解。
结论
我们得出结论，与疫情前我们人群的可用数据相比，COVID-19大流行对就诊延迟、乳腺癌治疗和疾病分期上调没有影响。然而项研究显示疾病分期上调与COVID状态之间存在显著相关性。这使我们重新考虑针对COVID阳性乳腺癌患者的既定方案。未来的研究人员可以利用我们的结果来调查COVID本身是否会导致乳腺癌分期上调的病理生理学变化。
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