Lin Queran, Li Shunrong, Shang Tongrui, Gui Xiujuan, Zhu Liling, Yang Yuan, Zhong Ziliang, Wang Xiaoyu, Dai Lingyan, Zhao Jianli, Xu Yanjie, Chen Qianru, Yan Qing, Huang Xiaoliang, Hu Wei, Liang Zijian, Song Erwei, He Jianrong, Ye Pengpeng, Chen Kai
Guangdong Provincial Key Laboratory of Malignant Tumour Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
Breast Tumour Centre, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China.
BMJ Open. 2025 Feb 2;15(1):e089188. doi: 10.1136/bmjopen-2024-089188.
Our study aims to evaluate the spatial and temporal changes of breast-conserving surgery (BCS) rates and influential factors of BCS in Guangdong Province, China.
DESIGN, SETTING AND PARTICIPANTS: This registry-based cohort study analysed the data of patients of all age groups, from the medical record cover page, which was mandatorily collected for inpatients by the Health Administrative Department of Guangdong Province, China. Patients with non-metastatic breast cancer, who underwent breast surgery between 2013 and 2019, were included.
We analysed the BCS rate in Guangdong Province between 2013 and 2019. Logistic regression was applied to investigate the association between patient-level influential factors and BCS, respectively. We used restricted cubic spline regression to model the non-linear association between hospital volume rank with BCS rate. Linear regression was used to evaluate the association between city-level parameters with BCS rate of each city.
A total of 93 521 patients with non-metastatic breast cancer, who underwent breast surgery, were included in the analyses. Among them, 10 949 (11.7%) had BCS, with the BCS rates increasing from 0.8% in 2013 to 19.2% in 2019. Patients who were older (vs <40 years, 40-49 years: adjusted OR 0.72, 95% CI 0.68 to 0.76; 50-59 years: 0.51, 95% CI 0.48 to 0.54; ≥60 years: 0.37, 95% CI 0.35 to 0.40) and married (vs unmarried, 0.64, 95% CI 0.59 to 0.70) were less likely to undergo BCS. Patients who were employed (vs unemployed, 1.58, 95% CI 1.49 to 1.68), received cross-city surgery (vs local surgery, 1.37, 95% CI 1.31 to 1.44), lived in a high-income city (vs low-income city, β=4.40, 95% CI 1.55 to 7.24) or in a city with a higher number of physicians per 100 000 residents (0.57, 95% CI 0.31 to 0.82) were more likely to receive BCS.
This study suggests a significant increase in BCS rates from 2013 to 2019 in Guangdong, China. Promotion of BCS is needed, particularly among older patients, lower-volume hospitals and economically underdeveloped areas. Healthcare system should be prepared to support the increased awareness of seeking BCS among younger patients with breast cancer by improving the availability of radiotherapy, multidisciplinary team and patients' education programme.
本研究旨在评估中国广东省保乳手术（BCS）率的时空变化及BCS的影响因素。
设计、设置与参与者：这项基于登记的队列研究分析了所有年龄组患者的数据，数据来自中国广东省卫生行政部门强制收集的住院病历封面页。纳入了2013年至2019年间接受乳腺手术的非转移性乳腺癌患者。
我们分析了2013年至2019年广东省的BCS率。分别应用逻辑回归研究患者层面影响因素与BCS之间的关联。我们使用受限立方样条回归对医院手术量排名与BCS率之间的非线性关联进行建模。采用线性回归评估城市层面参数与各城市BCS率之间的关联。
共有93521例接受乳腺手术的非转移性乳腺癌患者纳入分析。其中，10949例（11.7%）接受了BCS，BCS率从2013年的0.8%升至2019年的19.2%。年龄较大的患者（与<40岁相比，40 - 49岁：调整后OR 0.72，95%CI 0.68至0.76；50 - 59岁：0.51，95%CI 0.48至0.54；≥60岁：0.37，95%CI 0.35至0.40）以及已婚患者（与未婚相比，0.64，95%CI 0.59至0.70）接受BCS的可能性较小。就业患者（与失业相比，1.58，95%CI 1.49至1.68）、接受跨市手术的患者（与当地手术相比，1.37，95%CI 1.31至1.44）、居住在高收入城市的患者（与低收入城市相比，β = 4.40，95%CI 1.55至7.24）或居住在每10万居民中医生数量较多城市的患者（0.57，95%CI 0.31至0.82）接受BCS的可能性更大。
本研究表明，2013年至2019年中国广东省的BCS率显著上升。需要推广BCS，尤其是在老年患者、手术量较低的医院和经济欠发达地区。医疗保健系统应通过提高放疗的可及性、多学科团队和患者教育计划，做好准备以支持年轻乳腺癌患者对寻求BCS的认识提高。
