| ObjectiveBreast cancer is one of the most common malignant tumors in women.According to the National Cancer Statistics Report released by the National Cancer Center in January 2019,breast cancer ranks the 1st in the incidence of malignant tumors in women,with an annual incidence of about 304,000 in 2015,accounting for 17.10%of the incidence of malignant tumors in women.Breast cancer now is seriously affecting women’s physical and mental health and even threatening human lives.Over the past 30 years,breast-conserving surgery has been gradually developed and perfected,and has become one of the most important surgical procedures for early-stage breast cancer.Breast-conserving surgery takes the cosmetic effect and the quality of life of patients into account while ensuring the treatment effect.Compared with the 60%-70%breast-conserving surgery rate in developed countries,the breast-conserving rate in China is comparatively low,about 10%-24.3%,and there is a lot of room for improvement.At the same time,there is also an imbalance between different regions and hospitals in China in the implementation of breast-conserving surgery.Compared with breast cancer patients in European and American countries,there are many differences such as earlier age of onset,poorer prognosis and more patients with triple-negative breast cancer,etc.in Chinese breast cancer patients.The results of relevant clinical studies conducted by European and American countries may not be fully applicable to Chinese people.There are currently few multicenter clinical studies on early breast cancer surgery in the country,and data on this are not yet available.The purpose of this study is to explore the development of breast-conserving treatment for early-stage breast cancer in China,to provide a comprehensive description of the current status of breast-conserving treatment for early-stage breast cancer patients in China,and to explore the clinical characteristics of early-stage breast cancer patients in China,the differences between patients of different age groups and the factors influencing the differences in breast-conserving rates between different hospitals to provide data support for clinical research and data reference for clinical decision-making.MethodsBased on the Breast Surgery Group of the Chinese Medical Association,for the patients who underwent breast-conserving surgery from January 2018 to December 2018,a uniformly designed electronic questionnaire was used to collect demographic information,surgical modality,pathology,and information about the comprehensive treatment plan of the patients.The Spearman rank correlation method was used to check the correlation between variables and the statistical analysis was done in IBM SPSS 25.0 software.ResultsThe overall percentage of breast-conserving operations in the 34 participating hospitals was 14.62%,with significant differences between hospitals(0.82%-76.27%).The proportion of breast-conserving surgeries was significantly higher in the Eastern region(20.08%)than in other regions(p<0.001).There is a positive correlation between the proportion of breast-conserving surgeries and local medical resources as well as the level of economic development.The average age of breast-conserving patients in this study was 48.71±11.24 years,and about 10.8%were young breast cancer patients(<35 years).In terms of molecular typing,27.2%of patients were Luminal A type and 49.8%of patients were Luminal B type.9.7%and 13.3%of patients were HER-2 overexpression and TNBC type,respectively.Approximately 10.2%of patients underwent neoadjuvant chemotherapy preoperatively,80.7%underwent sentinel lymph node biopsy,and 88.2%had an intraoperative incisional margin width>5 mm.Subgroup analysis showed that the clinical characteristics of patients differed by region,with a higher proportion of patients with stage T1 in the eastern region(64.5%)than in the non-eastern region(56.7%),with the proportion of patients with tumor size≤1 cm in the eastern region being 16.3%,significantly higher than the 7.8%in the non-eastern region.For surgical treatment,the proportion of patients receiving neoadjuvant therapy and sentinel lymph node biopsies was slightly lower in the eastern region than in other regions,with statistically significant differences.There was a significant difference in tumor size between the different age groups(p<0.001).The proportion of patients with tumors≤1 cm in young breast cancer being significantly smaller than in other older groups,and the proportion of tumors>4 cm being significantly higher than in other older groups.Correspondingly,young breast cancer patients had a higher proportion of neoadjuvant chemotherapy(p<0.001)and ALND(p=0.002)than other groups,while more positive axillary lymph nodes(p<0.001)were detected.Besides,young breast cancer patients had a higher proportion of TNBC(19.2%)than other groups.Patients with tumors>2 cm were younger,and correspondingly,the proportion of premenopausal patients(56.9%)was greater than in the tumor≤2 cm group(62.9%).The proportion of tumors occurring in the outer upper quadrant was higher in the>2cm group(52.7%)than in the≤2cm group(46.5%)(p=0.001).In terms of treatment,the proportion of neoadjuvant therapy and ALND in the≤2cm group was significantly lower than that in the>2cm group,and the width of the breast-conserving surgical margins was not significantly different between the two groups.The proportion of HER-2 overexpressed breast cancer and TNBC in the>2cm group was greater than that in the ≤2cm group.Conclusion:At present,the rate of breast-conserving surgery for early-stage breast cancer patients in China is still low,and there is still a large gap compared with European and American countries.There are significant differences in the proportion of breast-conserving operations between regions and hospitals.Different subgroups of breast cancer patients have different clinical characteristics,and attention should be paid in future clinical work to better provide individualized treatment for patients. |
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