Analysis of factors influencing the choice of breast-conserving surgery after neoadjuvant chemotherapy for breast cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHOU Peng , ZHAO Mengfan , LI Huimin , LIU Fang ,  WU Bin

Department of Breast Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;

Corresponding author：

WU Bin, Email: wwbb129@sina.com

Keywords：

breast cancer; neoadjuvant chemotherapy; breast-conserving surgery; mastectomy; influence factor

DOI：

10.7507/1007-9424.202009039

Video：

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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.

Citation： ZHOU Peng, ZHAO Mengfan, LI Huimin, LIU Fang, WU Bin. Analysis of factors influencing the choice of breast-conserving surgery after neoadjuvant chemotherapy for breast cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(6): 779-784. doi: 10.7507/1007-9424.202009039 Copy

1.	Fisher B, Bryant J, Wolmark N, et al. Effect of preoperative chemotherapy on the outcome of women with operable breast cancer. J Clin Oncol, 1998, 16(8): 2672-2685.
2.	Fisher B, Brown A, Mamounas E, et al. Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-18. J Clin Oncol, 1997, 15(7): 2483-2493.
3.	Wolmark N, Wang J, Mamounas E, et al. Preoperative chemotherapy in patients with operable breast cancer: nine-year results from National Surgical Adjuvant Breast and Bowel Project B-18. J Natl Cancer Inst Monogr, 2001, 30: 96-102.
4.	Guarneri V, Broglio K, Kau SW, et al. Prognostic value of pathologic complete response after primary chemotherapy in relation to hormone receptor status and other factors. J Clin Oncol, 2006, 24(7): 1037-1044.
5.	Sethi D, Sen R, Parshad S, et al. Histopathologic changes following neoadjuvant chemotherapy in locally advanced breast cancer. Indian J Cancer, 2013, 50(1): 58-64.
6.	张燕娜, 孙强, 周易冬, 等. 知识宣教对乳腺癌患者保留乳房选择影响的前瞻性队列研究. 中华乳腺病杂志(电子版), 2015, 9(4): 257-263.
7.	张培, 李霞, 李国媛. 早期乳腺癌患者影响保乳手术选择的因素分析. 天津护理, 2013, 21(6): 479-481.
8.	周斌, 季科, 辛灵, 等. 美国肿瘤联合会乳腺癌分期系统(第8版)更新内容介绍及解读. 中国实用外科杂志, 2017, 37(1): 10-14.
9.	杨学宁, 吴一龙. 实体瘤治疗疗效评价标准一REClST. 循证医学, 2004, 4(2): 85-90, 111.
10.	Rippy EE, Ainsworth R, Sathananthan D, et al. Influences on decision for mastectomy in patients eligible for breast conserving surgery. Breast, 2014, 23(3): 273-278.
11.	Katz SJ, Lantz PM, Janz NK, et al. Patient involvement in surgery treatment decisions for breast cancer. J Clin Oncol, 2005, 23(24): 5526-5533.
12.	Romanek KM, McCaul KD, Sandgren AK. Age differences in treatment decision making for breast cancer in a sample of healthy women: the effects of body image and risk framing. Oncol Nurs Forum, 2005, 32(4): 799-806.
13.	Lam WW, Fielding R, Ho EY, et al. Surgeon’s recommendation, perceived operative efficacy and age dictate treatment choice by Chinese women facing breast cancer surgery. Psychooncology, 2005, 14(7): 585-593.
14.	郭方东. 保乳术与改良根治术对早期乳腺癌的疗效及术后生存质量比较. 中国现代普通外科进展, 2016, 19(1): 62-63.
15.	Senthi S, Link E, Chua BH. Cosmetic outcome and seroma formation after breast-conserving surgery with intraoperative radiation therapy boost for early breast cancer. Int J Radiat Oncol Biol Phys, 2012, 84(2): e139-e144.
16.	Yang Y, Cameron J, Humphris G. The relationship between cancer patient's fear of recurrence and radiotherapy: a systematic review and meta-analysis. Psychooncology, 2017, 26(6): 738-746.
17.	Yang Y, Wen Y, Bedi C, et al. The relationship between cancer patient’s fear of recurrence and chemotherapy: A systematic review and meta-analysis. J Psychosom Res, 2017, 98: 55-63.
18.	Koch L, Jansen L, Brenner H, et al. Fear of recurrence and disease progression in long-term (≥5 years) cancer survivors—a systematic review of quantitative studies. Psychooncology, 2013, 22(1): 1-11.
19.	Crist JV, Grunfeld EA. Factors reported to influence fear of recurrence in cancer patients: a systematic review. Psychooncology, 2013, 22(5): 978-986.
20.	张阳, 田丽, 王盼盼, 等. 乳腺癌患者癌症复发恐惧及影响因素分析. 广东医学, 2017, 38(23): 3658-3661.
21.	Kash KM, Holland JC, Halper MS, et al. Psychological distress and surveillance behaviors of women with a family history of breast cancer. J Natl Cancer Inst, 1992, 84(1): 24-30.
22.	Lerman C, Daly M, Sands C, et al. Mammography adherence and psychological distress among women at risk for breast cancer. J Natl Cancer Inst, 1993, 85(13): 1074-1080.
23.	Horowitz M, Wilner N, Alvarez W. Impact of event scale: a measure of subjective stress. Psychosom Med, 1979, 41(3): 209-218.
24.	Acharya S, Hsieh S, Michalski JM, et al. Distance to radiation facility and treatment choice in early-stage breast cancer. Int J Radiat Oncol Biol Phys, 2016, 94(4): 691-699.
25.	Collins IM, Lum C, Versace VL. Influence of socioeconomic factors and distance to radiotherapy on breast-conserving surgery rates for early breast cancer in regional Australia; implications of change. Asia Pac J Clin Oncol, 2018, 14(5): e224-e230.
26.	Nattinger AB, Kneusel RT, Hoffmann RG, et al. Relationship of distance from a radiotherapy facility and initial breast cancer treatment. J Natl Cancer Inst, 2001, 93(17): 1344-1346.
27.	周怡君, 英旻, 何英剑, 等. 原发性乳腺癌分子分型与新辅助化疗疗效的相关性分析. 中华医学杂志, 2013, 93(22): 1711-1714.
28.	Yoo C, Ahn JH, Jung KH, et al. Impact of immunohistochemistry-based molecular subtype on chemosensitivity and survival in patients with breast cancer following neoadjuvant chemotherapy. J Breast Cancer, 2012, 15(2): 203-210.
29.	Bonnefoi H, Litière S, Piccart M, et al. Pathological complete response after neoadjuvant chemotherapy is an independent predictive factor irrespective of simplified breast cancer intrinsic subtypes: a landmark and two-step approach analyses from the EORTC 10994/BIG 1-00 phase Ⅲ trial. Ann Oncol, 2014, 25(6): 1128-1136.
30.	Clarke M, Collins R, Darby S, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet, 2005, 366(9503): 2087-2106.
31.	Dunn LB, Aouizerat BE, Cooper BA, et al. Trajectories of anxiety in oncology patients and family caregivers during and after radiation therapy. Eur J Oncol Nurs, 2012, 16(1): 1-9.
32.	Sattaratnamai A, Samankatiwat N, Lohsiriwat V. Surgeons’ recommendation is the factor in determining the breast cancer surgery procedures: an experience from rural hospital in thailand. Asian Pac J Cancer Prev, 2018, 19(5): 1189-1193.
33.	Kirby RM, Basit A, Manimaran N. Patient choice significantly affects mastectomy rates in the treatment of breast cancer. Int Sem Surg Oncol, 2008, 5: 20.
34.	Teh YC, Shaari NE, Taib NA, et al. Determinants of choice of surgery in asian patients with early breast cancer in a middle income country. Asian Pac J Cancer Prev, 2014, 15(7): 3163-3167.

1. Fisher B, Bryant J, Wolmark N, et al. Effect of preoperative chemotherapy on the outcome of women with operable breast cancer. J Clin Oncol, 1998, 16(8): 2672-2685.
2. Fisher B, Brown A, Mamounas E, et al. Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-18. J Clin Oncol, 1997, 15(7): 2483-2493.
3. Wolmark N, Wang J, Mamounas E, et al. Preoperative chemotherapy in patients with operable breast cancer: nine-year results from National Surgical Adjuvant Breast and Bowel Project B-18. J Natl Cancer Inst Monogr, 2001, 30: 96-102.
4. Guarneri V, Broglio K, Kau SW, et al. Prognostic value of pathologic complete response after primary chemotherapy in relation to hormone receptor status and other factors. J Clin Oncol, 2006, 24(7): 1037-1044.
5. Sethi D, Sen R, Parshad S, et al. Histopathologic changes following neoadjuvant chemotherapy in locally advanced breast cancer. Indian J Cancer, 2013, 50(1): 58-64.
6. 张燕娜, 孙强, 周易冬, 等. 知识宣教对乳腺癌患者保留乳房选择影响的前瞻性队列研究. 中华乳腺病杂志(电子版), 2015, 9(4): 257-263.
7. 张培, 李霞, 李国媛. 早期乳腺癌患者影响保乳手术选择的因素分析. 天津护理, 2013, 21(6): 479-481.
8. 周斌, 季科, 辛灵, 等. 美国肿瘤联合会乳腺癌分期系统(第8版)更新内容介绍及解读. 中国实用外科杂志, 2017, 37(1): 10-14.
9. 杨学宁, 吴一龙. 实体瘤治疗疗效评价标准一REClST. 循证医学, 2004, 4(2): 85-90, 111.
10. Rippy EE, Ainsworth R, Sathananthan D, et al. Influences on decision for mastectomy in patients eligible for breast conserving surgery. Breast, 2014, 23(3): 273-278.
11. Katz SJ, Lantz PM, Janz NK, et al. Patient involvement in surgery treatment decisions for breast cancer. J Clin Oncol, 2005, 23(24): 5526-5533.
12. Romanek KM, McCaul KD, Sandgren AK. Age differences in treatment decision making for breast cancer in a sample of healthy women: the effects of body image and risk framing. Oncol Nurs Forum, 2005, 32(4): 799-806.
13. Lam WW, Fielding R, Ho EY, et al. Surgeon’s recommendation, perceived operative efficacy and age dictate treatment choice by Chinese women facing breast cancer surgery. Psychooncology, 2005, 14(7): 585-593.
14. 郭方东. 保乳术与改良根治术对早期乳腺癌的疗效及术后生存质量比较. 中国现代普通外科进展, 2016, 19(1): 62-63.
15. Senthi S, Link E, Chua BH. Cosmetic outcome and seroma formation after breast-conserving surgery with intraoperative radiation therapy boost for early breast cancer. Int J Radiat Oncol Biol Phys, 2012, 84(2): e139-e144.
16. Yang Y, Cameron J, Humphris G. The relationship between cancer patient's fear of recurrence and radiotherapy: a systematic review and meta-analysis. Psychooncology, 2017, 26(6): 738-746.
17. Yang Y, Wen Y, Bedi C, et al. The relationship between cancer patient’s fear of recurrence and chemotherapy: A systematic review and meta-analysis. J Psychosom Res, 2017, 98: 55-63.
18. Koch L, Jansen L, Brenner H, et al. Fear of recurrence and disease progression in long-term (≥5 years) cancer survivors—a systematic review of quantitative studies. Psychooncology, 2013, 22(1): 1-11.
19. Crist JV, Grunfeld EA. Factors reported to influence fear of recurrence in cancer patients: a systematic review. Psychooncology, 2013, 22(5): 978-986.
20. 张阳, 田丽, 王盼盼, 等. 乳腺癌患者癌症复发恐惧及影响因素分析. 广东医学, 2017, 38(23): 3658-3661.
21. Kash KM, Holland JC, Halper MS, et al. Psychological distress and surveillance behaviors of women with a family history of breast cancer. J Natl Cancer Inst, 1992, 84(1): 24-30.
22. Lerman C, Daly M, Sands C, et al. Mammography adherence and psychological distress among women at risk for breast cancer. J Natl Cancer Inst, 1993, 85(13): 1074-1080.
23. Horowitz M, Wilner N, Alvarez W. Impact of event scale: a measure of subjective stress. Psychosom Med, 1979, 41(3): 209-218.
24. Acharya S, Hsieh S, Michalski JM, et al. Distance to radiation facility and treatment choice in early-stage breast cancer. Int J Radiat Oncol Biol Phys, 2016, 94(4): 691-699.
25. Collins IM, Lum C, Versace VL. Influence of socioeconomic factors and distance to radiotherapy on breast-conserving surgery rates for early breast cancer in regional Australia; implications of change. Asia Pac J Clin Oncol, 2018, 14(5): e224-e230.
26. Nattinger AB, Kneusel RT, Hoffmann RG, et al. Relationship of distance from a radiotherapy facility and initial breast cancer treatment. J Natl Cancer Inst, 2001, 93(17): 1344-1346.
27. 周怡君, 英旻, 何英剑, 等. 原发性乳腺癌分子分型与新辅助化疗疗效的相关性分析. 中华医学杂志, 2013, 93(22): 1711-1714.
28. Yoo C, Ahn JH, Jung KH, et al. Impact of immunohistochemistry-based molecular subtype on chemosensitivity and survival in patients with breast cancer following neoadjuvant chemotherapy. J Breast Cancer, 2012, 15(2): 203-210.
29. Bonnefoi H, Litière S, Piccart M, et al. Pathological complete response after neoadjuvant chemotherapy is an independent predictive factor irrespective of simplified breast cancer intrinsic subtypes: a landmark and two-step approach analyses from the EORTC 10994/BIG 1-00 phase Ⅲ trial. Ann Oncol, 2014, 25(6): 1128-1136.
30. Clarke M, Collins R, Darby S, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet, 2005, 366(9503): 2087-2106.
31. Dunn LB, Aouizerat BE, Cooper BA, et al. Trajectories of anxiety in oncology patients and family caregivers during and after radiation therapy. Eur J Oncol Nurs, 2012, 16(1): 1-9.
32. Sattaratnamai A, Samankatiwat N, Lohsiriwat V. Surgeons’ recommendation is the factor in determining the breast cancer surgery procedures: an experience from rural hospital in thailand. Asian Pac J Cancer Prev, 2018, 19(5): 1189-1193.
33. Kirby RM, Basit A, Manimaran N. Patient choice significantly affects mastectomy rates in the treatment of breast cancer. Int Sem Surg Oncol, 2008, 5: 20.
34. Teh YC, Shaari NE, Taib NA, et al. Determinants of choice of surgery in asian patients with early breast cancer in a middle income country. Asian Pac J Cancer Prev, 2014, 15(7): 3163-3167.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

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

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