摘要
目的研究中国10年乳腺癌手术治疗方式的发展与变迁，比较分析乳腺癌手术治疗方式的选择在中国不同地区之间的差异。方法从中国女性原发性乳腺癌10年（1999-2008）抽样回顾性调查数据库中提取与乳腺癌手术治疗相关资料。结果乳腺癌10年抽样（每年抽取1个月的全部收治病例）回顾性调查住院病历4211例，行手术病例4078例，其中乳腺癌改良根术3271例（80．21％），1999年乳腺癌改良根治术率为68．89％，2008年为80．17％，10年上升了11．28个百分点（x。=31．143，P〈0．001）。保乳手术231例（5．66％），1999年保乳手术率为1．29％，2008年为11．57％，10年上升了10．28个百分点（X^2=102．835，P〈0．001）。Halsted根治术469例（11．50％），1999年Halsted根治术率为28．28％，2008年为4．96％，10年下降了23．32个百分点（，=206．202，P〈0．001）。乳房切除手术（Halsted根治术十改良根治术＋乳房单纯切除术）合计3786例（92．84％），1999年乳房切除手术率为98．46％，2008年为86．36％，10年下降了12．10个百分点（g2=95．744，P〈0．001）。在中国东、南部经济相对发达地区，1999年乳腺癌改良根治术率为45．64％，2008年为76．13％，10年上升了30．49个百分点（X^2=89．393，P〈0．001）；在中国中、西部经济欠发达地区，乳腺癌改良根治术率较高，每年均超过80％，10年变化不大（X^2=2．113，P=0．146）。在中国东、南部经济相对发达地区，1999年保乳手术率为2．68％，2008年为16．87％，10年上升了14．19个百分点（X^2=69．544，P〈0．001）；在中国中、西部经济欠发达地区，1999年保乳手术率为0．42％，2008年为6．22％，10年上升了5．80个百分点（X^2=30．003，P〈0．001）。在中国东、南部经济相对发达地区，1999年乳腺癌Halsted根治术率高达50．34％，2008年为3．29％，10年下降了47．05个百分点（X2=274．830，P〈0．001）；在中国中、西部经济欠发达地区，1999年Halsted根治术率为14．58％，2008年为6．64％，10年下降了7．94个百分点（r=8．166，P=0．004）。在中国东、南部经济相对发达地区，1999年乳房切除手术率为96．64％，2008年为80．66％，10年下降了15．98个百分点（X^2=53．446，P〈0．001）；在中国中、西部经济欠发达地区，1999年乳房切除手术率为99．58％，2008年为92．12％，10年下降了7．46个百分点（X2=36．758，P〈0．001）。结论中国1999年—2008年间乳腺癌手术以改良根治术为主，保乳手术比例不高但呈上升趋势，乳腺癌Halsted根治术逐渐被改良根治术和保乳手术所取代。在中国东、南部经济相对发达地区，乳腺癌乳房切除手术率的下降趋势和保乳手术率的上升趋势均较中、西部经济相对欠发达地区明显。保乳手术治疗将成为中国早期乳腺癌的主要治疗模式。
Objective To investigate the changes and development of surgical treatment for breast cancer from 1999 to 2008 in China, and compare the differences between the surgical methods used in high-resource and low-resource areas. Methods Clinicopathological data of surgical treatment for female primary breast cancer was collected via medical chart review at hospitals in seven geographic areas in China. Chisquare test and ehisqure test for linear trends were used to analyze the changes and development of the surgical methods used for breast cancer in the 10 years. Results A total of 4211 primary breast cancer patients were selected from the 10-year database, including 4078 women （97.5%） treated by surgical operation. Among 3271 women （80. 21% ） treated with modified radical mastectomy, the surgical rate was rising from 68.89% in 1999 to 80.17% in 2008, ascending by 11.28% （X^2 =31. 143, P 〈0.001 ）. In high-resource areas, the surgical rate of modified radical mastectomy was rising from 45.64% in 1999 to 76.13% in 2008, ascending by 30.49% （X^2 = 89. 393, P 〈 0.001 ） , while in low-resource areas it kept a steady rate at 80% in the ten years （X^2 = 2. 113,P = 0. 146）. Among 231 women （5. 66%） treated with breastconserving surgery, the surgical rate was rising from 1.29% in 1999 to 11.57% in 2008, ascending by 10.28% （X^2 = 102.835, P 〈0. 001 ）. In high-resource areas, the surgical rate of breast-conserving surgery was rising from 2.68% in 1999 to 16.87% in 2008, ascending by 14.19% （X^2 = 69. 544, P 〈 0. 001 ） , while in low-resource areas it was rising from 0.42% in 1999 to 6.22% in 2008, ascending by 5.80% （X^2 = 30. 003, P 〈 0.001 ）. Among 469 women （ 11.50% ） treated with Halsted radical mastectomy, the surgical rate was declining from 28.28% in 1999 to 4.96% in 2008, descending by 23.32% （X^2 = 206. 202, P 〈 0.001 ）. In high-resource areas, the surgical rate of Halsted radical mastectomy was declining from 50.34% in 1999 to 3.29% in 2008, descending by 47.05% （X^2 = 274. 830, P 〈 0. 001 ）, while in low-resource areas it was declining from 14.58% in 1999 to 6.64% in 2008, descending by 7.94% （X^2 = 8. 166, P = 0.004）. Among 3786 women treated with breast masteetomy （including modified radical masteetomy and Halsted radical mastectomy） , the surgical rate was declining from 98.46% in 1999 to 86.36% in 2008, descending by 12.10% （X^2 = 95. 744, P 〈 0. 001 ）. In high-resource areas, the surgical rate of breast mastectomy was declining from 96. 64% in 1999 to 80. 66% in 2008, descending by 15.98% （X^2 = 53. 446, P 〈0. 001 ）, while in low-resource areas it was declining from 99.58% in 1999 to 92.12% in 2008, descending by 7.46% （X^2 = 36. 758,P 〈 0. 001 ）. Conclusions The main primary surgical treatment for breast cancer is modified radical masteetomy during the period 1999-2008. Halsted radical masteetomy is gradually replaced by modified radical mastectomy and breast-conserving surgery. The rate of changes for breastconserving surgery and mastectomy is higher in high-resource areas than that in low-resource areas. Breastconserving surgery will become the main treatment for early-stage breast cancer.
出处
《中华肿瘤杂志》
CAS
CSCD
北大核心
2012年第8期582-587,共6页
Chinese Journal of Oncology
基金
中国癌症基金会
关键词
乳腺肿瘤
外科手术
回顾性研究
Breast neoplasms
Surgical procedures, operative
Retrospective studies
