| Breast Cancer is the most common malignancy in women.According to the latest statistics published in "Cancer statistics,2022",breast cancer cases account for 31%of new cancer cases in women,and its incidence has been increasing globally in recent years.The situation of female breast cancer in China is also severe.Research shows that breast cancer incidence rate is the first female cancer incidence rate.The number of female breast cancer cases continues to rise,Compared with 2015,it is expected to increase by 36.27%in 2023.Breast cancer has seriously threatened the safety of female population.Surgery is the basic treatment to treat early and middle stage breast cancer.Breast conserving surgery refers to the operation of simple tumor resection and breast preservation for early breast cancer.A number of studies have shown that there is no statistical significance in the long-term survival rate and disease-free recurrence rate of breast conserving surgery(BCS)and mastectomy(MAS).More and more real-world studies show that patients undergoing BCS have a better prognosis.At present,BCS has become the mainstream surgical method in Europe and the United States,and the rate of BCS is 60%-70%.The rate of BCS in China is only 21.9%,which is far from Europe and the United States.This article retrospectively analyzed the data of 1995 breast cancer patients who underwent surgical treatment in the Department of Breast Surgery,the Second Hospital of Shandong University from January 2011 to December 2021,in order to study the change trend of rate of BCS and the influencing factors of BCS decision,evaluate its prognosis.Provide local evidence-based medical evidence for optimizing the choice of surgeries for patients.Objectives:1.To study the variation trend and influencing factors of rate of BCS from 2011 to 2021 in our hospital.2.To analyze the factors influencing the decision of BCS in recent years.3.To study the prognosis of patients with different surgical methods.Methods:The data of breast cancer patients who underwent radical surgery in the Department of Breast Surgery,the Second Hospital of Shandong University from 2011 to 2021 were retrospectively analyzed.According to their surgical methods(BCS or MAS),they were divided into BCS group and MAS group.The demographic and clinicopathological factors of the patients were obtained by consulting the electronic medical records,and the survival status.Time of first recurrence or time of death were obtained by comprehensive outpatient follow-up and telephone follow-up.The continuous variables of the data were expressed as mean±standard deviation,the categorical variables were expressed as examples(%),the independent sample t test and the chi-square test were used for intergroup comparison.Cochran-Armitage test was used to analyze the change trend of rate of BCS and rate of MAS.Univariate and multivariate binary logistic regression analysis were used to analyze the influencing factors affecting the decision-making of surgical methods for breast cancer.Kaplan-Meier method was used to draw the survival curve,and Log-rank test was used to test the survival of patients after accpting BCS and MAS,including Disease Free Survival(DFS)and Overall Survival(OS).After adjusting for confounding factors,multivariate COX was used to evaluate the effect of surgical methods on prognosis,and propensity score matching(PSM)was used for sensitivity analysis.SPSS 26.0 and SAS 9.4 statistical software were used for data statistical analysis.IF P<0.05,the difference was statistically significant.Results:1.Overall population dataA total of 1995 patients were included,including 424 patients in the BCS group and 1571 patients in the MAS group.Compared with the patients in the MAS group,the patients in the BCS group were younger(median age of patients was 49 years old vs 51 years old,P<0.001),premenopausal patients accounted for a large proportion(P<0.001),tumor size of patients was smaller(P<0.001),patients of axillary lymph node metastasis accounted for a small proportion(P<0.001),Neo-Adjuvant Chemotherapy(NAC)patients accounted for a small proportion(P<0.001),patients of breast MRI(Magnetic Resonance Imaging)accounted for a small proportion(P<0.001),patients of puncture biopsy accounted for a small proportion(P<0.001).Pathological aspects,compared with the patients in the MAS group,patients in the BCS group of invasive ductal carcinoma accounted for a large proportion(P<0.001),the proportion of Progesterone Receptor(PR)positive patients accounted for a large proportion(P<0.001),the proportion of Human Epidermalgrowth Factor Receptor 2(Her-2)negative patients accounted for a small proportion(P=0.001).2.Trend of breast conserving surgery rateAmong the study population,the BCS rate increased from 17.48%in 2011 to 36.82%in 202 1,and the trend test showed that the upward trend was statistically different(Ptrend<0.001).Tumor size at first diagnosis,breast MRI,puncture biopsy were independent factors affecting the change of BCS rate(P<0.001).3.The factors of influencing surgery decision-makingAge,tumor size at first diagnosis,axillary lymph node status at first diagnosis and breast MRI were independent factors affecting the choice of surgery for breast cancer patients.Older patients(OR=0.61,95%CI:0.47-0.79,P<0.001),patients with small tumors at first diagnosis(OR=0.55,95%CI:0.46-0.67,P<0.001),patients with positive axillary lymph nodes at first diagnosis(OR=0.49,95%CI:0.34-0.70,P<0.001),patients who hadn’t undergone puncture biopsy(OR=0.40,95%CI:0.30-0.54,P<0.001),patients undergoing breast MRI(OR=6.73,95%CI:5.17-8.75,P<0.001)were less likely to choose BCS.4.Survival and prognosis analysisThere were 1689 patients with complete follow-up data.The median follow-up time of the BCS group was 38 months(3-13 6 months),13 cases(3.8%)recurred and 3 cases(0.9%)died.The median follow-up time of the MAS group was 49 months(2-140 months),139 cases(10.3%)recurred and 48 cases(3.6%)died.Log-rank test showed that DFS(P=0.002)and OS(P=0.024)in BCS group were higher than those in MAS group.Sensitivity analysis after PSM matching(n=344)still showed that DFS(P=0.048)and OS(P=0.019)in BCS group were higher than those in MAS group.Multivariate COX regression analysis showed that after adjusting for confounding factors such as tumor size,axillary lymph node status,NAC and pathological type,patients who underwent BCS had a 47%lower risk of recurrence than those who underwent MAS(HR=0.53,95%CI:0.30-0.95,P=0.034).Sensitivity analysis after PSM matching still showed that patients who underwent BCS had a 74%lower risk of death compared with those who had MAS(HR=0.26,95%CI:0.08-0.87,P=0.029).Conclusion:1.The rate of BCS showed an overall upward trend.2.Age,tumor size at first diagnosis,axillary lymph node status at first diagnosis,breast MRI and puncture biopsy were factors affecting the choice of surgery for breast cancer patients.3.Compared with MAS,BCS can significantly improve the disease-free survival and overall survival of patients. |
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