保乳手术用于治疗Ⅰ期和Ⅱ期乳腺癌。

Use of breast-conserving surgery for treatment of stage I and stage II breast cancer.

作者信息

Guadagnoli E, Weeks J C, Shapiro C L, Gurwitz J H, Borbas C, Soumerai S B

机构信息

Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA.

出版信息

J Clin Oncol. 1998 Jan;16(1):101-6. doi: 10.1200/JCO.1998.16.1.101.

DOI:10.1200/JCO.1998.16.1.101

PMID:9440729

Abstract

PURPOSE

To assess the use of breast-conserving surgery in two states reported to differ with respect to surgical treatment of breast cancer.

METHODS

A retrospective cohort study based on data collected from medical records and patients was performed among 1,514 patients diagnosed with early-stage breast cancer in Massachusetts and 1,061 patients in Minnesota. Patients were identified at 18 randomly selected hospitals in Massachusetts and at 30 hospitals in Minnesota. The rate of breast-conserving surgery in both states and the correlates of breast-conserving surgery among women eligible for the procedure were determined.

RESULTS

The rate of breast-conserving surgery in both states was much higher than previously reported. Among those eligible for the procedure, nearly 75% underwent breast-conserving surgery in Massachusetts and nearly half did so in Minnesota. Significantly (P < .003) more women who underwent mastectomy in Minnesota (27%) than in Massachusetts (15%) reported that their surgeon did not discuss breast-conserving surgery with them. Among women who underwent mastectomy and who reported being informed of both surgical alternatives, more women (P < .001) in Minnesota (74%) than in Massachusetts (62%) said they ultimately chose mastectomy because their surgeon recommended it. In Massachusetts, women treated at teaching hospitals were twice as likely as other women to undergo breast-conserving surgery. In Minnesota, women over age 70 and those who lived in rural areas were less likely than other women to undergo breast-conserving surgery.

CONCLUSION

Although the rate of breast-conserving surgery in each state was higher than expected based on earlier reports, the rates differed considerably between states. Additional studies are needed to determine whether variation in practice between geographic areas is due to differences in patients' preferences and values or to surgeons' propensity for one type of surgery based on where they practice.

摘要

目的

评估在据报道乳腺癌手术治疗方式存在差异的两个州中保乳手术的使用情况。

方法

基于从医疗记录和患者处收集的数据，对马萨诸塞州1514例诊断为早期乳腺癌的患者和明尼苏达州1061例患者进行了一项回顾性队列研究。患者是在马萨诸塞州随机选择的18家医院和明尼苏达州的30家医院中确定的。确定了两个州的保乳手术率以及符合该手术条件的女性中保乳手术的相关因素。

结果

两个州的保乳手术率均远高于先前报道。在符合该手术条件的患者中，马萨诸塞州近75%接受了保乳手术，明尼苏达州近一半接受了保乳手术。在明尼苏达州接受乳房切除术的女性（27%）比在马萨诸塞州（15%）显著更多（P <.003）报告称其外科医生未与她们讨论保乳手术。在接受乳房切除术且报告知晓两种手术选择的女性中，明尼苏达州（74%）比马萨诸塞州（62%）有更多女性（P <.001）表示她们最终选择乳房切除术是因为外科医生推荐。在马萨诸塞州，在教学医院接受治疗的女性接受保乳手术的可能性是其他女性的两倍。在明尼苏达州，70岁以上的女性和居住在农村地区的女性比其他女性接受保乳手术的可能性更小。