Factors Affecting The Choice Of Operation And Prognosis In Patients With Breast Ductal Carcinoma In Situ

Background: Breast cancer is the most common malignant tumor in women all over the world,which is a serious threat to women’s health.Ductal carcinoma in situ(DCIS)is an early breast malignant tumor whose dysplastic epithelial cells are confined to the breast duct and does not exceed the surrounding basement membrane.In recent years,it accounts for an important proportion of new breast cancer.Typical DCIS shows cluster-like microcalcification or sand-like calcification on mammography,which makes this kind of early breast cancer can be found in breast cancer screening to some extent.Surgery is the first choice and main treatment for DCIS.How to improve the rate of breast-conserving surgery,avoid unnecessary mastectomy and achieve more accurate individualized treatment while ensuring the curative effect of surgical treatment,there is still no clear conclusion on the factors affecting the choice of surgical methods for patients with DCIS at home and abroad.Therefore,study the influencing factors of total mastectomy or breast conservation in patients with DCIS,has a certain clinical significance.Purpose: 1.Collect the complete clinical data of DCIS patients,analyze the factors affecting the choice of operation methods for DCIS patients.2.Through the follow-up of the collected patients,the effects of different surgical methods on the disease-free survival of the patients were analyzed.Methods: 1.A total of 183 patients with DCIS confirmed by pathology were collected from the Department of Breast surgery of Liaoning Cancer Hospital from October 2012 to August 2015,including total mastectomy(n = 109)and breast conserving(n = 74).The clinical and histopathological features were analyzed,including age,menstruation,nipple discharge,mammography,tumor location,ipsilateral breast lesions,tumor size,apparent diffusion coefficient,time-signal intensity curve classification,diffusion-weighted imaging signal,biopsy mode,operation mode,nuclear grade,histopathoiogic type,ER,PR,HER2,Ki-67 and so on.2.The patients in the two groups were followed up for 5 years,and the recurrence or progression of the disease was recorded.3.Statistical analysis using SPSS22.0 statistical software analysis system.The factors affecting the choice of surgical methods in patients with DCIS were analyzed by univariate analysis,and then taking the surgical methods as dependent variables and the statistically significant variables in univariate analysis as independent variables,binary Logistic regression analysis was carried out.The effects of different surgical methods on the prognosis of patients were analyzed by Kaplan-Meier method and Log-rank test.Statistically significant(P<0.05).Result:Total mastectomy was performed in 109 cases(59.56%),and breast conserving surgery was performed in 74 cases(40.44%).Age ≥ 60 years old(OR=0.029,P < 0.001),diffuse tumor location(OR=0.038,P < 0.001),puncture biopsy(OR=0.275,P=0.040),maximum tumor diameter > 2cm and ≤ 5cm(OR=0.085,P < 0.001)were the independent influencing factors of rejecting breast-conserving surgery.The 5-year disease-free survival between total mastectomy and breast conserving surgery combined with radiotherapy was 95.41% and 94.59% respectively,and the difference was not statistically significant(P > 0.05)。...