Department of Radiation Oncology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
School of Medicine, Tzu Chi University, Hualien, Taiwan.
Breast Cancer Res Treat. 2022 Jun;193(3):659-667. doi: 10.1007/s10549-022-06579-3. Epub 2022 Apr 16.
Breast-conserving surgery (BCS) followed by whole breast radiation therapy (BCS-WBRT) or total mastectomy without WBRT (TM-no-WBRT) is the primary treatment for early stage breast cancer patients. Our study aimed to identify which early stage breast cancer treatment strategies had a subsequent lower incidence rate of mood disorder over a period of 10 years after the primary treatment.
This retrospective cohort study consisted of newly diagnosed early stage breast cancer patients in Taiwan from 2000 to 2013 using the National Health Insurance Research Database in Taiwan. We used a 1:1 propensity score matching by age to enrol patients into the BCS-WBRT and TM-no-WBRT groups. Statistical analyses were performed to calculate the hazard ratio and cumulative incidence rate.
Our study consisted of 876 BCS-WBRT patients and 1949 TM-no-WBRT patients. After propensity score matching, each study group included 876 patients. The results showed that the mood disorder incidence rate was lower in the BCS-WBRT group than in the TM-no-WBRT group. Multivariate Cox regression analysis revealed that the BCS-WBRT group had a decreased risk of developing mood disorder (adjusted hazard ratio 0.69, 95% CI 0.53-0.90, p < 0.01). Furthermore, the Kaplan-Meier analysis showed that the BCS-WBRT group had a lower cumulative incidence rate of mood disorder, especially depression, after undergoing 10 years of primary treatment (p = 0.004).
Our results indicated that BCS-WBRT was associated with a lower risk of development of mood disorder over a 10-year period compared to TM-no-WBRT in early stage breast cancer patients. Our findings may provide helpful information, along with other clinical data, for breast cancer patients as they choose the type of appropriate surgery for treatment.
保乳手术（BCS）联合全乳放射治疗（BCS-WBRT）或不联合 WBRT 的全乳切除术（TM-no-WBRT）是早期乳腺癌患者的主要治疗方法。本研究旨在确定在原发性治疗后 10 年内，哪种早期乳腺癌治疗策略的情绪障碍发生率较低。
本回顾性队列研究使用台湾全民健康保险研究数据库，纳入了 2000 年至 2013 年期间台湾新诊断的早期乳腺癌患者。我们通过年龄进行 1:1 倾向评分匹配，将患者纳入 BCS-WBRT 和 TM-no-WBRT 组。采用统计分析计算风险比和累积发生率。
本研究纳入了 876 例 BCS-WBRT 患者和 1949 例 TM-no-WBRT 患者。经过倾向评分匹配后，每组各纳入 876 例患者。结果显示，BCS-WBRT 组的情绪障碍发生率低于 TM-no-WBRT 组。多变量 Cox 回归分析显示，BCS-WBRT 组发生情绪障碍的风险降低（调整风险比 0.69，95%CI 0.53-0.90，p<0.01）。此外，Kaplan-Meier 分析显示，BCS-WBRT 组在原发性治疗 10 年后情绪障碍（尤其是抑郁症）的累积发生率较低（p=0.004）。
与 TM-no-WBRT 相比，早期乳腺癌患者接受 BCS-WBRT 治疗后 10 年内发生情绪障碍的风险较低。我们的研究结果可能为乳腺癌患者在选择合适的治疗手术类型时提供有价值的信息，同时结合其他临床数据进行综合考虑。
