| Background:Breast cancer is one of the most common female malignant tumors.The main surgical treatment for early breast cancer is mastectomy and breast conserving surgery.However,the breast-conserving surgery rate of early breast cancer in China is still lower than the United States and other developed countries.At present,there is a lack of comprehensive analysis of the influencing factors of surgical treatment for patients who eligible for breast-conserving surgery.Objective:To analyze the influences on decision for breast-conserving surgery or mastectomy in patients eligible for breast-conserving surgery.In order to improve the breast-conserving rate of patients who eligible for breast conserving surgery,and bring better curative effect and better postoperative appearance for patients.Methods:A total of 513 patients who were pathologically diagnosed as early breast cancer and met the inclusion criteria in the Department of Breast surgery of the second Hospital of Jilin University from January 2017 to December 2019were selected and sent out electronic or paper questionnaires.We utilized telephone to explain the purpose of the study to the patient who met the inclusion criteria.Then the researchers obtained the patient’s consent,issued an electronic questionnaire,and provided interpretation and guidance.All questionnaires were collected in time after completion.And patients were excluded if they do not meet the completion criteria.The results of the questionnaires were analyzed statistically:statistical analysis was undertaken using SPSS 21.0 software.Results:According to the inclusion criteria,a total of 513 breast cancer patients were identified as being suitable for BCS of which 360 chose to undergo total mastectomy and 153 undergo breast conserving surgery.(1)Personal objective factors Univariate analysis found that age(X~2=40.507,P<0.01),educational level(X~2=28.005,P<0.01),residence(X~2=13.043,P<0.01),per capita monthly income of family(X~2=27.591,P<0.01)and health care type(X~2=31.908,P<0.01)have an impact on the choice of surgical treatment.Logistic regression multivariate analysis found that age(≤40),per capita monthly income of family(2500-5000,>5000)and health care type(medical insurance for workers and residents)were related to patients’choice of breast-conserving surgery.In addition,the age(41-50,51-60,≥61),per capita monthly income of family(<2500)and health care type(rural cooperative medical insurance)were related to patients’choice of mastectomy.(2)Clinical characteristic data Univariate analysis found that the stage of T have an impact on the choice of surgical treatment(X~2=39.074,P<0.01).Logistic regression multivariate analysis found that the stage of Tis and T1were related to patients’choice of breast-conserving surgery.(3)Individual subjective factors Univariate analysis found that surgeon advice(X~2=38.160,P<0.01),postoperative radiotherapy(X~2=17.030,P<0.01),family opinion(X~2=16.679,P<0.01),patient opinion(X~2=39.546,P<0.01),self-image(X~2=53.567,P<0.01),risk of recurrence(X~2=12.502,P<0.01),operation cost(X~2=10.976,P<0.01)and other channel information(X~2=25.356,P<0.01)have an impact on the choice of surgical treatment.Logistic regression multivariate analysis found that surgeon advice and self-image were related to patients’choice of breast-conserving surgery.Additionally,the other channel information,postoperative radiotherapy and patient opinion were related to patients’choice of mastectomy.(4)Various factors of radiotherapy Logistic regression multivariate analysis found that the cost(OR=0.55,95%CI is 0.44～0.69,P<0.05)and duration(OR=0.74,95%CI is 0.57～0.95,P<0.05)of radiotherapy are related to the choice of mastectomy.Conclusion:(1)Patients with age≤40 years,per capita monthly income of≥2500yuan,workers’or residents’health care type tend to elect breast-conserving surgery;patients with age≥41 years,per capita monthly income less than2500 yuan and holding rural cooperative medical insurance tend to choose mastectomy.(2)The patients with Tis and T1 staging are inclined to elect breast-conserving surgery;and the patients with T2 staging are inclined to choose mastectomy.(3)Patients who focus on doctors’advice and self-image are important tend to choose breast-conserving surgery;patients who focus on postoperative radiotherapy,patients’opinions and other channel information tend to choose mastectomy.(4)Patients with mastectomy indicate that the cost and duration of radiotherapy belong to important factors affecting their surgical treatment. |
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