乳腺癌新辅助化疗后影响保乳手术选择的因素分析

Analysis of factors influencing the choice of breast-conserving surgery after neoadjuvant chemotherapy for breast cancer

目的探讨新辅助化疗后符合保乳条件的乳腺癌患者手术方式选择的影响因素。方法对228例经新辅助化疗后符合保乳条件的乳腺癌患者进行问卷调查,采用卡方检验、非参数秩和检验以及二元logistic回归方法对手术方式选择的影响因素进行单因素和多因素分析。结果单因素分析结果显示:患者年龄、临床分期、癌症家族史、分子分型、新辅助化疗疗效、外科医生的建议、化疗不良反应以及手术并发症是影响患者手术方式选择的因素(P<0.05)。多因素分析结果显示:新辅助化疗疗效[OR=0.312,95%CI为(0.255,0.662),P<0.001]以及外科医生的建议[OR=53.947,95%CI为(4.570,6.239),P=0.002]是影响患者手术方式选择的独立因素。结论手术方式的决策是医生与患者共同参与的过程,个体化的化疗方案提高缓解率,以及外科综合治疗理念及策略的进展对提高保乳率和保乳成功率具有重要意义,医生应结合患者具体情况给予积极的引导,共同作出最优选择。

Objective To investigate the factors of breast cancer patients who met breast-conserving conditions after neoadjuvant chemotherapy when choosing surgical mode.Methods A questionnaire survey was conducted on 228 breast cancer patients who met breast-conserving conditions after neoadjuvant chemotherapy.Chi square test,nonparametric rank sum test and binary logistic regression were used to analyze the factors affecting the choice of surgical mode.Results Univariate analysis showed that age,clinical stage,family history of cancer,molecular type,neoadjuvant chemotherapy effect,surgeon’s recommendation,chemotherapy side effects,and surgical complications were the factors affecting patient’s chose for breast-conserving surgery(P<0.05).Multivariate analysis showed that the effect of neoadjuvant chemotherapy[OR=0.312,95%CI(0.255,0.662),P<0.001]and the surgeon’s recommendation[OR=53.947,95%CI(4.570,6.239),P=0.002]were independent factors that affected the choice of surgery.Conclusions The decision of the surgical mode is a process in which doctors and patients participate together.Individualized neoadjuvant chemotherapy improves the remission rate and the progress of the surgeon’s comprehensive treatment strategy can play a role in improving the breast-conserving rate and the rate of breast-conserving success.Doctors should give positive guidance in accordance with the specific situation of the patient to make the best choice.