文章摘要
张佩雯,张辉,李明爽,林艺丹,孙静,林孟波,刘远立.基于医患双方的女性早期乳腺癌选择保乳手术的影响因素研究[J].中华流行病学杂志,2021,42(11):2044-2052
基于医患双方的女性早期乳腺癌选择保乳手术的影响因素研究
Factors associated with selection of breast-conserving surgery in early female patients with breast cancer
收稿日期:2021-05-16  出版日期:2021-11-20
DOI:10.3760/cma.j.cn112338-20210516-00402
中文关键词: 乳腺癌;保乳手术;术式决策;交互作用
英文关键词: Breast cancer;Breast-conserving surgery;Surgical decision-making;Interaction effect
基金项目:中国医学科学院北京协和医学院课题(医科公卫2019年22号)
作者单位E-mail
张佩雯 中国医学科学院北京协和医学院卫生健康管理政策学院, 北京 100710  
张辉 福建省立医院肿瘤外科, 福州 350001  
李明爽 中国医学科学院北京协和医学院群医学与公共卫生学院, 北京 100710  
林艺丹 福建省立医院肿瘤外科, 福州 350001  
孙静 中国医学科学院北京协和医学院卫生健康管理政策学院, 北京 100710 sunjing@sph.pumc.edu.cn 
林孟波 福建省立医院肿瘤外科, 福州 350001 fzsllmb@123.com 
刘远立 中国医学科学院北京协和医学院卫生健康管理政策学院, 北京 100710  
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中文摘要:
      目的 分析早期乳腺癌患者选择保乳手术的影响因素。方法 选取2015年1月1日至2019年12月31日在福建省立医院确诊为早期乳腺癌并接受手术治疗的女性患者作为研究对象。通过医院信息系统及电子问卷分别收集患者及其主治医生的相关资料。采用二分类logistic多元回归模型分析影响因素。结果 医生年龄、患者年龄、患者所在地区的居民人均可支配年收入是患者选择保乳手术的影响因素。在其他变量不变的条件下,相对于低收入地区,中等收入地区的患者更有可能接受保乳手术(OR=1.91,95%CI:1.01~3.62,P=0.05);患者的主治医生平均年龄45岁时,患者年龄每增加1岁,选择保乳手术预测概率降低4%(95%CI:-0.07~-0.01,P=0.01);患者平均年龄52岁时,其主治医生年龄每增长1岁,选择保乳手术的预测概率降低10%(95%CI:-0.19~-0.01,P=0.03)。医、患年龄的交互作用对部分医、患显著,平均影响效应为0.06%(Z=2.11,sx=0.000 3,P<0.05)。结论 促进符合适应证的早期乳腺癌女性患者选择保乳手术,需要考虑医、患双方的因素。
英文摘要:
      Objective To analyse the factors associated with the selection of breast- conserving surgery in early female patients with breast cancer. Methods The targeted patients were females diagnosed with early-stage breast cancer and received surgical treatment at Fujian Provincial Hospital from January 1, 2015, to December 31, 2019. The targeted patients' clinical, demographic, and social-economic characteristics were extracted from the hospital health information system. Relevant information of their attending surgeons was collected through a smart-phone based self-respond online survey. We performed multivariate logistic regression to explore the associated factors with breast-conserving surgery (BCS) decision-making. Results The age of the patient and attending surgeon and the economic development level of the patient's residence area were the associated factors with BCS decision-making of female early-stage breast cancer. By controlling the other factors unchanged, patients from middle-income areas were more likely to accept BCS (OR=1.91, 95%CI:1.01-3.62, P=0.05) than those from low-income areas. When the attending surgeon was at the average age of 45 years old, increasing of 1 year age of patient led to 4% decrease of the probability of BCS (95%CI:-0.07--0.01, P=0.01). When the patient was at the average age of 52 years old, increasing of 1 year age of the attending surgeon reduced 10% of the probability of BCS (95%CI:-0.19--0.01, P=0.03). The interaction effects related to the age of attending surgeon and patient for some observations to choose BCS were statistically significant, and the average interaction effect was 0.06% (Z=2.11, sx=0.000 3, P<0.05). Conclusion To promote breast-conserving surgery in the indicated early female patients with breast cancer, it is necessary to consider factors from both the surgeons and the patients.
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