Department of Nursing, School of Medicine, Xiamen University, Xiamen, P.R. China.
Department of Breast Surgery, First Affiliated Hospital, Xiamen University, Xiamen, P.R. China.
BMC Cancer. 2023 Jan 6;23(1):23. doi: 10.1186/s12885-023-10510-4.
The breast-conserving surgery and reconstruction rate in China is relatively low when compared with those in Western countries. Moreover, predictors of surgical choices for women with breast cancer in China have not yet been explored. This study aims to explore differences in the surgical choices of women with different demographic and clinical characteristics and the predictors that influence surgical choices of women with early-stage breast cancer.
This retrospective study included women with early-stage (0-II) breast cancer who underwent surgeries at one of two Xiamen University-affiliated hospitals between 2009 and 2017. Using medical records, eleven variables were collected: the woman's age, year of diagnosis, hospital, marital status, payment method, cancer stage, presence of positive axillary lymph node, histology, neoadjuvant chemotherapy, radiotherapy, and the type(s) of surgery they chose. Binary logistic regression was used to analyse predictors of surgical choice.
A total of 1,787 cases were included in this study. Of the total number of women with breast cancer, 61.3% underwent mastectomy without breast reconstruction, 26.4% underwent mastectomy with breast reconstruction, and the remaining 12.2% chose breast-conserving surgery. Women with different demographic and clinical characteristics underwent different types of surgery. Cancer stage, neoadjuvant chemotherapy, radiotherapy, and the choice of hospital were found to be predictors of breast-conserving surgery. Meanwhile, age, year of diagnosis, payment method, neoadjuvant chemotherapy, and the choice of hospital were found to be predictors of reconstruction after mastectomy in women with early-stage breast cancer.
In China, surgical choices for women with breast cancer have diversified. Healthcare workers should understand the surgical preferences of women of different ages. For early detection of breast cancer, knowledge of breast self-examination and breast cancer screening should be provided. Adequate information about the safety of reconstruction and advocacy for medical insurance coverage of reconstruction should be offer. Breast surgeons need specialised training and standardising protocols towards different types of breast surgery. These actions will help women make better, well-informed decisions about their breast surgeries.
相较于西方国家，中国保乳手术和重建手术的比例相对较低。此外，中国尚未探讨影响乳腺癌女性手术选择的预测因素。本研究旨在探讨不同人口统计学和临床特征的女性手术选择的差异，以及影响早期乳腺癌女性手术选择的预测因素。
本回顾性研究纳入了 2009 年至 2017 年在厦门大学附属的两家医院接受手术的早期（0-II 期）乳腺癌女性患者。通过病历资料，共收集了 11 个变量：女性年龄、诊断年份、医院、婚姻状况、支付方式、癌症分期、阳性腋窝淋巴结的存在、组织学、新辅助化疗、放疗和选择的手术类型。使用二元逻辑回归分析手术选择的预测因素。
本研究共纳入 1787 例病例。在所有乳腺癌女性中，61.3%行乳房切除术且未行乳房重建，26.4%行乳房切除术联合乳房重建，12.2%选择保乳手术。不同人口统计学和临床特征的女性行不同类型的手术。癌症分期、新辅助化疗、放疗和医院选择被发现是保乳手术的预测因素。同时，年龄、诊断年份、支付方式、新辅助化疗和医院选择被发现是早期乳腺癌女性行乳房重建术的预测因素。
在中国，乳腺癌女性的手术选择呈现多样化。医护人员应了解不同年龄段女性的手术偏好。为了早期发现乳腺癌，应提供乳房自检和乳腺癌筛查的相关知识。应提供关于重建安全性的充分信息，并倡导医疗保险覆盖重建。乳腺外科医生需要接受专门的培训，并针对不同类型的乳腺手术制定标准化方案。这些措施将有助于女性做出更好、知情的乳腺手术决策。
