Higgins Áine, O'Reilly Seamus, O'Sullivan Martin J
Department of Breast Surgery, Cork University Hospital and University College Cork, Cork, Ireland.
Department of Medical Oncology, College of Medicine and Health, Cork University Hospital and Cancer Research@UCC, University College Cork, Cork, Ireland.
Ir J Med Sci. 2024 Aug;193(4):1763-1772. doi: 10.1007/s11845-024-03688-4. Epub 2024 Apr 19.
The coronavirus-19 (COVID-19) pandemic caused delays in the diagnosis and management of breast cancer which may have affected disease presentation. The aim of this study was to compare rates of metastatic disease, tumour characteristics and management in breast cancer patients diagnosed before and after the onset of COVID-19.
A retrospective chart review was conducted on patients in a university teaching hospital who were diagnosed with invasive symptomatic breast cancer in 2019 (prepandemic control group) and in 2020, 2021, and 2022 (pandemic study groups). Rates of new metastatic presentations, tumour histopathological characteristics, operation type, and therapies administered were statistically compared.
A total of 1416 patients were identified. There was a significant increase in new metastatic breast cancer presentations in 2022 compared to 2019 (14.0% vs 3.8%, p ≤ 0.001), with non-significant increases in 2020 and 2021. Rates of adjuvant radiotherapy increased in 2020 and decreased in 2022 compared to 2019, with no significant change in neoadjuvant or adjuvant chemotherapy rates. Rates of axillary surgery increased during 2020 and 2021. There was an increase in high-grade tumours and lymphovascular invasion (LVI), and less frequent oestrogen receptor (ER) positivity in pandemic groups. No significant change was noted in BCS to mastectomy ratios, overall nodal positivity rates, or median tumour size.
Symptomatic breast cancers diagnosed since the onset of COVID-19 demonstrated an increase in new metastatic presentations and more aggressive histopathological characteristics when compared to a pre-pandemic control group. Rates of adjuvant radiotherapy and axillary surgery increased during the pandemic.
2019冠状病毒病（COVID-19）大流行导致乳腺癌的诊断和治疗延迟，这可能影响了疾病表现。本研究的目的是比较在COVID-19大流行开始之前和之后确诊的乳腺癌患者的转移疾病发生率、肿瘤特征及治疗情况。
对一所大学教学医院中在2019年（大流行前对照组）以及2020年、2021年和2022年（大流行研究组）被诊断为侵袭性症状性乳腺癌的患者进行回顾性病历审查。对新出现转移的发生率、肿瘤组织病理学特征、手术类型和所给予的治疗进行统计学比较。
共识别出1416例患者。与2019年相比，2022年新出现转移的乳腺癌病例显著增加（14.0%对3.8%，p≤0.001），2020年和2021年有非显著性增加。与2019年相比，2020年辅助放疗率增加，2022年下降，新辅助或辅助化疗率无显著变化。2020年和2021年腋窝手术率增加。大流行组中高级别肿瘤和淋巴管浸润（LVI）增加，雌激素受体（ER）阳性率降低。保乳手术与乳房切除术的比例、总体淋巴结阳性率或肿瘤大小中位数无显著变化。
与大流行前对照组相比，自COVID-19大流行开始以来诊断出的症状性乳腺癌新出现转移的病例增加，组织病理学特征更具侵袭性。大流行期间辅助放疗率和腋窝手术率增加。
