| Objective: The realization of breast-conserving surgery through neoadjuvant chemotherapy can meet the dual needs of breast cancer patients for disease treatment and the pursuit of quality of life.However,there are still some patients who meet the breast-conserving conditions after neoadjuvant chemotherapy choose to undergo mastectomy.Therefore,this study analyzes the factors influencing the selection of surgical methods for breast cancer patients who meet the breast-conserving conditions after neoadjuvant chemotherapy,and provides a scientific basis for clinical surgical decisions.Methods:Selected from June 2017 to June 2020 in the Department of Breast Surgery,The Affiliated Hospital of Southwest Medical University,pathological examination of 228 patients diagnosed as breast cancer,and after neoadjuvant chemotherapy,eligible for breast-conserving surgery were selected as the research object and questionnaire survey.The content of the questionnaire was revised based on relevant research results at home and abroad,combined with practical problems in clinical work and the characteristics of patients with neoadjuvant chemotherapy.The investigators are composed of medical staff in this research group.Before filling out the questionnaire,they use a unified explanatory language to explain the precautions and filling requirements to the patients.After obtaining the consent of the patients,the questionnaire is issued.All the scales will be retrieved with a unified number after they are filled out.Use SPSS22.0 statistical software to sort out and analyze the results of the questionnaire,and use the Chi-square test to perform single-factor analysis of the differences in the classification data,and then combine the statistically significant factors with the clinical reality,which may affect the patient’s choice of surgery The factors were analyzed by binary logistic regression,and the difference was statistically significant at P<0.05.Results:Univariate analysis found that age,clinical stage,family history of cancer,molecular type,neoadjuvant chemotherapy effect,surgeon’s recommendation,chemotherapy side effects,and surgical complications were statistically significant between the breast-conserving group and the mastectomy group(P<0.05).Multivariate analysis found that the efficacy of neoadjuvant chemotherapy and the surgeon’s recommendations are independent factors that affect the choice of surgical methods.Patients with better neoadjuvant chemotherapy are more likely to choose breast-conserving surgery.Patients with CR are 8.697 times more likely to choose breast-conserving surgery than patients with SD(OR=8.697,95%CI 1.82-41.569,P=0.007),the patients with PR were 7.215 times more likely to choose breast-conserving surgery than the patients with SD(OR=7.215,95%CI 1.567-33.218,P=0.011).The degree of surgeon’s recommends is more severe,and the patients are more likely to choose breast-conserving.The surgeon strongly recommends are5.034 times more likely to choose breast-conserving surgery than those who do not recommend breast-conserving surgery(OR=5.034,95%CI 1.554-16.308,P=0.007),the surgeon recommends with "average" are 4.359 times more likely to choose breast-conserving surgery than those who do not recommend breast-conserving surgery(OR =4.359,95%CI 1.38-13.765,P=0.012).Conclusion:The decision of the surgical mode is a process in which doctors and patients participate together.The selection of surgical mode is a process of joint decision-making between doctors and patients.Individualized comprehensive treatment plans improve the efficacy of neoadjuvant and the formation of good professionalism of breast specialists is of great significance for optimizing the surgical decision-making of breast cancer patients after neoadjuvant chemotherapy.Doctors should give positive guidance in accordance with the specific situation of the patient to make the best choice.Doctors should give positive guidance in accordance with the specific situation of the patient to make the best choice. |
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